Characterizing the risk of HLA-incompatible living donor kidney transplantation in older recipients
Author Department
Surgery
Document Type
Article, Peer-reviewed
Publication Date
9-2023
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.
Keywords: HLA-incompatible; clinical research/practice; kidney transplantation; living donor; older; outcomes.
Recommended Citation
Long JJ, Motter JD, Jackson KR, Chen J, Orandi BJ, Montgomery RA, Stegall MD, Jordan SC, Benedetti E, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Verbesey JE, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Wellen JR, Bozorgzadeh A, Gaber AO, Heher EC, Weng FL, Djamali A, Helderman JH, Concepcion BP, Brayman KL, Oberholzer J, Kozlowski T, Covarrubias K, Massie AB, McAdams-DeMarco MA, Segev DL, Garonzik-Wang JM. Characterizing the risk of HLA-incompatible living donor kidney transplantation in older recipients. Am J Transplant. 2023 Sep 23:S1600-6135(23)00698-6. doi: 10.1016/j.ajt.2023.09.010. Epub ahead of print.
PMID
37748554