Delayed Graft Function Is Associated with an Increased Risk of Early Death Post-Transplant in Elderly Kidney Transplant Recipients

Abstract

The proportion of elderly kidney transplant recipients worldwide continues to grow over time. Even in patients aged over 70, transplantation confers a long-term survival benefit compared to dialysis. However, there remains a higher risk of death in the first 125 days post-transplant in these patients. Therefore, understanding risk factors for death early post-transplant is important in the elderly. In most regions, elderly patients are more likely to receive a deceased donor transplant kidney from older donors, which may confer a DGF. We sought to examine the impact of DGF on early post-transplant survival in elderly transplant recipients. Methods: Using data from the USRDS, we utilized Cox PH models to examine the association of DGF with death within the first 6 months post-transplant in deceased donor kidney transplant recipients aged 18-39 (n=17,366), 40-49 (n=18,047), 50-59 (n=21,333), 60-69 (n=15,333), and 70+ years (n=4308) during 1997-2007. Results: The incidence of DGF was similar in all age groups, ranging from 20-23%. The table outlines the hazards for death in the first 6 months post-transplant in those with DGF compared to those without DGF in each age group, unadjusted and adjusted for donor, recipient, and transplant factors. In each model, DGF was associated with a higher hazard of death within the first 6 months in recipients aged 70 and older, whereas this was not seen in other age groups.Table: [Hazard for Death (including death after graft loss]Conclusions: DGF is associated with a higher risk of death in the early post-transplant period in elderly recipients. These results highlight the need to tailor allocation of organs and peri-operative management in the elderly to minimize the risk DGF and its associated impact on early death post-transplant.