89 Frailty in Renal Transplantation: Retrospective Cohort Study to Examine the Impact of the New 2019 Kidney Offering Scheme on Older Transplant Recipients

Abstract

Abstract Background In 2019, a new kidney offering scheme was launched in the United Kingdom, aiming to better match estimated patient survival and graft life expectancy. The impact of the scheme on older patients undergoing kidney transplantation (KT) is unknown. Aim This study aims to compare outcomes of elderly KT recipients before and after the introduction of the 2019 kidney offering scheme. Method A retrospective cohort study of two groups of elderly patients who underwent KT was undertaken. Group 1 included patients transplanted between 01/09/2017 and 31/08/2019 as part of the “2006 allocation scheme”. Group 2 included patients transplanted between 01/09/2019 and 31/08/2021 as part of the “2019 offering scheme”. An elderly patient was defined as any person over 60 years of age at the time of KT. Univariate binary logistic regression analysis was performed to determine odds ratios (OR) and 95% confidence intervals. Results There were 107 elderly deceased donor KT recipients; 62 from Group 1 and 45 from Group 2. The median age at transplantation was 68 years (62-71) and 67 years (64-73), respectively. Univariate analysis showed that level four HLA mismatch (OR 4.667 95%CI 1.640-13.275, p = 0.004) and a requirement for re-intervention (OR 6.496 95%CI 1.306-32.216, p = 0.022) were significantly more likely in the 2019 offering scheme. One year graft survival worsened on introduction of the 2019 offering scheme (85% vs 80%). Conclusions The introduction of the 2019 offering scheme has led to less favourable HLA matches, increased need for reintervention, and a lower one-year graft survival in elderly KT recipients.