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Abstract: SA-PO827

Survival Differences in Elderly Patients on Renal Replacement Therapy

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Tegzess, Erzsi, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Peters-Sengers, Hessel, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
  • Pol, Robert, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Sanders, Jan-Stephan, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Berger, Stefan P., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
Background

Rising numbers of elderly patients (≥65 years) are in need of renal replacement therapy (RRT), with a growing proportion being waitlisted for kidney transplantation. To date little is known about the effect of living versus deceased donor kidney transplantation in these recipients. This study investigated the differences in patient survival between elderly kidney transplant recipients with a living donor (LDK), a young (<65, YDK) or an old (≥65, ODK) deceased donor kidney and compared it to waitlisted dialysis patients (≥63).

Methods

In this nation-wide retrospective cohort study survival was investigated using a multi-state model with Cox regression analysis in elderly patients waitlisted and transplanted between 2000 and 2019 in the Netherlands.

Results

4138 patients were included in this study (65.5% male, age 68 [65-71]), with 1374 (33.2%) remaining waitlisted. Out of the 2762 (66.7%) patients who received a kidney transplant, 1095 (39.6%) had a LDK, 672 (24.3%) a YDK and 997 (36.1%) an ODK. Median patient survival from start of RRT in was significantly lower in patients remaining waitlisted (4.51 years) compared to those who received a transplant (9.54 years, p<0.001). Waiting time on dialysis was significantly longer for YDK [2.5 years (1.4-3.8)] and ODK [2.6 (1.7-3.7)] compared to LDK [0.0 (0.0-1.4)] recipients. 5 year survival from start of RRT did not differ significantly between donor types (82.4%), but median survival from start of RRT was significantly lower in ODK (8.88 years, p<0.001) patients compared to the LDK (10.06 years) and YDK (10.28 years) recipients. After correction for potential confounders, survival still did not differ significantly between LDK (Ref.) and YDK [HR 1.19 (0.99-1.44), p=0.081] recipients, but was lower in ODK [HR 1.67 (1.39-1.99)] recipients.

Conclusion

For elderly recipients starting RRT, there was a limited survival difference between donor categories, with slightly lower survival for ODK recipients. Additionally, deceased donor kidney recipients have a longer waiting time, which carries a significantly increased risk of mortality. However, ultimately, all donor types had satisfactory survival, with any type of transplantation having a clear survival benefit over dialysis.

Funding

  • Government Support – Non-U.S.