Abstract: FR-PO1033

Factors Affecting Kidney Transplant Outcome in Very Old Recipients of Grafts from Very Old Donors

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Trujillo Cuellar, Hernando, Hospital 12 de Octubre, Madrid, Spain
  • Andres, Amado, Hospital 12 de Octubre, Madrid, Spain
  • Santiago, Garcia Ana, Hospital 12 de Octubre, Madrid, Spain
  • Cavero escribano, Teresa, Hospital 12 de Octubre, Madrid, Spain
  • Moliz, Candela, Hospital 12 de Octubre, Madrid, Spain
  • Redondo navarro, Beatriz, Hospital Universitario 12 de Octubre, Madrid, Spain
  • Bada bosch, Teresa, Hospital Universitario 12 de Octubre, Madrid, Spain
  • Praga, Manuel, Hospital 12 de Octubre, Madrid, Spain
  • Gonzalez monte, Esther, Hospital 12 de Octubre, Madrid, Spain
Background

Kidney transplantation is the best option for elderly patients with end stage renal disease. The major limitation in this group of patients is shortage of donors since kidneys from young donors are assigned to younger recipients. Spain had 43,4 donors pmp in 2016, 30% of them were aged over 70 years. Kidneys from these donors can be assigned to older patients without detriment to young recipients.

Methods

We performed a retrospective analysis of pretransplant clinical factors associated with graft and recipient survival in elderly patients (≥70 years) that received a kidney transplant from a very old donor (≥70 years) at our institution from October 2004 to December 2013 (and followed through April 25, 2017) (n = 155).

Results

Median age of donors and recipients was 77 (74-79) and 75 (73-78) years, respectively. The 3-year and 5-year patient survival was 73.1% and 67.1%. Mortality in the first year was 15.9%. Death censored graft survival was 83.4% at year 3 and 80.8% at year 5. History of cerebrovascular disease in the recipient was the only factor associated with patient survival (HR 5.12, p=0.027), while history of diabetes mellitus in the recipient was the only factor associated with the risk of graft loss (HR 4.40, p=0.0001).

Conclusion

Kidney transplantation from very old donors in patients over 70 years offers a survival advantage over staying on dialysis. History of cerebrovascular disease in the recipient was associated with an increased risk of recipient mortality, while history of diabetes in the recipient was associated with increased risk of graft loss. Further studies are needed to identify pretransplant clinical factors associated with increased risk of graft failure and recipient mortality in this population in order to improve allocation of these old allografts in the elderly patients.

Donor characteristicsn = 112
Sex, n(%), male

Age, Md (IQR), years

Weight, Md (IQR), kg

SCr, Md (IQR), mg/dL

Hypertension, n(%)

Diabetes mellitus, n(%)

Cerebrovascular cause of death, n(%)

Glomerulosclerosis on kidney biopsy, n(%)
<15%
15-20%
21-30%
31-50%
50 (44.6)

77 (74-79)

70 (65-80)

0.8 (0.7-0.9)

72 (66.1)

35 (32.1)

16 (14.3)


72 (87.8)
8 (9.8)
1 (1)
1 (1)
Recipient characteristicsn = 155
Sex, n(%), male

Age, Md (IQR), years

Weight, Md (IQR), kg

Dialysis duration before transplantation, Md (IQR), months

Previous kidney transplant, n(%)

Diabetes mellitus, n(%)

Coronary artery disease, n(%)

Cerebrovascular disease, n(%)

HLA mismatch, n(%)

Cold ischemia time, Md (IQR), hours
95 (61.3)

75 (73-78)

68 (61-75)

12 (5-24)

16 (10.3)

61 (39.4)

17 (11)

18 (11.6)

4 (4-5)

22 (19.5-25)

Funding

  • Private Foundation Support