Abstract: FR-PO1048

Removal Rates and Reasons from Waitlist in Elderly Kidney Transplant Candidates in the United States

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Phonphok, Korntip, UCLA, Los Angeles, California, United States
  • Cho, Yong W, Mendez National Institution of Transplantation, Los Angeles, California, United States
  • Bunnapradist, Suphamai, UCLA, Los Angeles, California, United States
Background

The number of kidney transplant candidates on waiting list has been increasing over year, as well as the median age at initial registration. Since now there are 97,621 candidates on waitlist, among these 22,290 (22. 8%) are 65 years old and older (Data of June 1, 2017). Over 30,000 patients were removed from waiting list by year due to various reasons. We hypothesized that elderly candidates would have higher waitlist removal rates and less likely to achieve successful transplantation.

Methods

We used data from the Organ Procurement Transplant Network (OPTN/UNOS) as of December 8, 2016. We examined rates and reasons of waitlist removal in 137,553 kidney transplant candidates registered between January 1, 2000, and September 30, 2015. To allow for a sufficient follow-up period, candidates registered for transplantation up to September 31, 2015 (1 year before the date of last follow-up in the database) were included. Those candidates who were put on waitlists for organs other than kidney or multiple organs were excluded. We divided patients into 3 groups based on age at initial registration; 1) aged 60-69 years, 2)aged 70-79 years, and 3)aged ≥ 80 years. Reasons for waitlist removal were defined as being transplanted, delisted, and death.

Results

A total of 56,544 (48.3%) candidates were removed from waitlist over the study period due to reasons other than being transplanted. Delisting rate was increased by age group and was highest in aged ≥ 80 group. Among these, 22,908 (19.6%) were removed due to death during on waiting list. Candidates aged ≥ 80 years had the highest number of delisting due to condition unsuitable for transplant and also demonstrated worst patient survival while waiting for a transplant. (p<0.01) (graph)

Conclusion

Elderly kidney transplant candidates had high delisting rates due to death and condition unsuitable for transplant especially in those aged ≥ 80 years at initial registration, with decreased patient survival. Only half of them received successful transplantation. These results imply that patient selection before waitlist registration could avoid high rate of delisting.