Kidney Week

Abstract: TH-PO1017

Clinical Outcomes of Kidney Transplantation vs. Hemodialysis in Older Adults: A Propensity Score-Matched Analysis

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Lee, Yu ho, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Yu ho Lee, MD, PhD

• Ryu, Jiyeon, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jiyeon Ryu, RD

• Lee, Jeong-Yeun, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jeong-Yeun Lee, MD

• Yoon, Soo-Young, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Soo-Young Yoon, MD, PhD

• Kim, Jinsug, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jinsug Kim, MD

• Jeong, Kyunghwan, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Kyunghwan Jeong, MD, PhD

• Hwang, Hyeon Seok, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Hyeon Seok Hwang, MD, PhD

Background

Kidney transplantation (KT) in elderly patients remains controversial due to concerns regarding post-transplant complications and limited comparative data with non-transplant populations. This study aimed to compare clinical outcomes between elderly KT recipients and elderly hemodialysis patients using a nationwide registry-based cohort.

Methods

Elderly patients aged ≥65 years were identified from the Korean Network for Organ Sharing (KONOS) database. KT recipients were compared with hemodialysis patients who were listed for kidney transplantation. Propensity score matching was performed to minimize baseline differences. The primary outcomes were all-cause mortality, cardiovascular events, infection requiring hospitalization, and cancer development.

Results

After propensity score matching, 797 elderly KT recipients and 2,028 matched hemodialysis patients were included. KT recipients were male predominant and had shorter duration of dialysis compared to hemodialysis patients. Elderly KT recipients showed significantly lower risks of all-cause mortality and cardiovascular events compared with hemodialysis patients (adjusted hazard ratio [HR] = 0.61, 95% confidence interval [CI] = 0.49 – 0.76 and adjusted HR = 0.57, 95% CI = 0.43 – 0.76, respectively). In contrast, the risk of infection requiring hospitalization was higher in KT recipients, particularly during the early post-transplant period, but gradually stabilized over time (adjusted HR = 1.26, 95% CI = 1.09 – 1.45). The risk of cancer did not differ significantly between the two groups.

Conclusion

In elderly patients with end-stage kidney disease, KT was associated with improved survival and cardiovascular outcomes compared with hemodialysis, despite a higher early risk of infection-related hospitalization. These findings support KT as a viable treatment option for selected elderly patients, emphasizing the need for careful infection monitoring, especially in the early post-transplant period.