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Kidney Week

Abstract: PO2461

Infectious Complications and Malignancy After Kidney Transplant in the Elderly Population

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Liriano-Ward, Luz E., Montefiore Medical Center, Bronx, New York, United States
  • Al Azzi, Yorg, Montefiore Medical Center, Bronx, New York, United States
  • Pynadath, Cindy T., Montefiore Medical Center, Bronx, New York, United States
  • Ajaimy, Maria, Montefiore Medical Center, Bronx, New York, United States
  • Loarte Campos, Pablo, Montefiore Medical Center, Bronx, New York, United States
  • Nandigam, Purna Bindu, Montefiore Medical Center, Bronx, New York, United States
  • Akalin, Enver, Montefiore Medical Center, Bronx, New York, United States
Background

Kidney transplantation improves quality of life and survival in all patients regardless of age. However, older patients are prone to development of side effects related to immunosuppressive medications including infections and malignancy. We aim to evaluate clinical outcomes in recipients >65 years of age.

Methods

We retrospectively reviewed all patients over the age of 18 who received an isolated renal transplant at our center from January 2013 to June 2017. We compared clinical outcomes including allograft and patient survival, as well as the development of infections and malignancy in patients > 65 compared to younger patients.

Results

Of 624 patients analyzed, 148 (24%) were > 65 years of age. There was no difference in terms of gender, race, immunosuppressive or induction therapy between the two groups. Older patients were more likely to receive a deceased donor kidney transplant (92% vs. 81%, p=0.009). During a median 48 months (28, 70) of follow-up, as expected mortality was higher in older patients (16% vs. 6.5%, p=0.0001) but there was no difference in terms of death-censored graft loss (10.8% to 9%, p=0.52) compared to younger patients. Detailed analysis of infections revealed that there was no difference in terms of BKV and CMV viremia, pneumonia, bacteremia, influenza and c. diff between the two groups. However, older patients had more fungal and urinary tract infections and malignancy. The most common infection in the elderly was PJP pneumonia (4%), candidemia (3%), and cryptococcal infection (2%). The most common malignancy in the elderly was skin cancer (6%) followed by prostate (2%), lung (1%), and colon (1%).

Conclusion

Recipients older than 65 had similar graft survival compared to younger patients, but had a higher incidence of fungal and urinary tract infections and malignancies.

Clinical outcomesPatients age > 65 Patients age =< 65p-value
BKV22%19%0.43
CMV12%9%0.25
Influenza8%10%0.47
Pneumonia23.7%20%0.38
Bacteremia20%18%0.55
C diff colits8%4.5%0.07
Urinary tract infections49%31%< 0.0001
Fungal infections10.5%5.1%0.02
Malignancy16%5%< 0.0001