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Characterizing the risk of HLA-incompatible living donor kidney transplantation in older recipients. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Long, J. J., Motter, J. D., Jackson, K. R., Chen, J., Orandi, B. J., Montgomery, R. A., Stegall, M. D., Jordan, S. C., Benedetti, E., Dunn, T. B., Ratner, L. E., Kapur, S., Pelletier, R. P., Roberts, J. P., Melcher, M. L., Singh, P., Sudan, D. L., Posner, M. P., El-Amm, J. M., Shapiro, R., Cooper, M., Verbesey, J. E., Lipkowitz, G. S., Rees, M. A., Marsh, C. L., Sankari, B. R., Gerber, D. A., Wellen, J. R., Bozorgzadeh, A., Gaber, A. O., Heher, E. C., Weng, F. L., Djamali, A., Helderman, J. H., Concepcion, B. P., Brayman, K. L., Oberholzer, J., Kozlowski, T., Covarrubias, K., Massie, A. B., McAdams-DeMarco, M. A., Segev, D. L., Garonzik-Wang, J. M. 2023

Abstract

Older compatible living donor kidney transplant recipients (CLDKT) have higher mortality and death-censored graft failure compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant recipients (ILDKT) who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997 and December 15, 2016, we compared mortality, death-censored graft failure (DCGF), delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age=60) and 1172 younger (age 18-59) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17,542 CLDKT recipients, we used an interaction term to determine whether the relationship between post-transplant outcomes and transplant type (ILDKT vs. CLDKT) was modified by age. Overall, older recipients had higher mortality (HR: 1.632.072.65, p<0.001), lower DCGF (HR: 0.360.530.77, p=0.001) and AR (OR: 0.390.540.74, p<0.001), and similar DGF (OR: 0.461.032.33, p=0.9) and LOS (IRR: 0.880.981.10, p=0.8) compared to younger recipients. The impact of age on mortality (interaction p=0.052), DCGF (interaction p=0.7), AR interaction p=0.2), DGF (interaction p=0.9), and LOS (interaction p=0.5) was similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.

View details for DOI 10.1016/j.ajt.2023.09.010

View details for PubMedID 37748554