Characteristics and Early Outcomes of Older Adults Undergoing Kidney Transplantation

BACKGROUND: Kidney transplantation (KT) has increased over the last decades due to longer life expectancy and a higher incidence of end stage renal disease (ESRD). Knowledge gaps remain regarding outcomes and infectious complications in older adults. Our primary aim was to describe the infectious complications, rejection episodes, graft and patient survival among older KT recipients (KTr) during the first 12-months post-transplant. METHODS: Retrospective cohort study of all KT performed at Duke on older adults aged ≥65 years between 2011 and 2015. Demographic, clinical and outcome data were collected from the medical chart. Descriptive analyses were performed. RESULTS: Ninety-one kidney-only transplants had been performed between 2011–2015. 60.4% were males, predominantly Caucasian (61.5%) and had a median age of 68 (range 65–75). 73.6% were on chronic dialysis prior to transplant. Frequent comorbidities included hypertension (93.4%), diabetes mellitus (47.3%), cardiovascular disease (49.5%) and obesity (36.3%). 92.3% of this KTr population encountered at least one infectious complication in the 12 months after transplant, while only 7.7% had a rejection episode. Delayed graft function occurred in 26.4%. 71.4% were admitted at least once in the 12 months after KT. The most frequent reason for admission were infections (58% of the admissions), followed by lab abnormalities (25.5%) and surgical complications (20.4%), while only 1.3% were due to a cardiovascular event. Mortality at one year was 9.9%, graft loss 3.3%. CONCLUSION: Infectious complications occur at very high frequency in older KTr which in turn results in frequent hospital readmissions in the year following transplants. Despite these complications, the majority of older KTr were alive with a functioning graft one-year post-transplant. Cardiovascular events in this population are not as frequent as described in the literature. We postulate that a better understanding of immunosuppressive regimens and antimicrobial prophylaxis might be able to mitigate infectious complications. DISCLOSURES: M. Hemmersbach Miller, T32 Research Grant (NIH): I’m currently on a T32 Transplant ID Training Grant, Grant recipient and T32 Training Grant recipient - 4T32AI100851-04. K. Schmader, Merck: Investigator, Research grant. GlaxoSmithKline: Investigator, Research grant