Renal Transplant Outcome in Hispanics Septuagenarians and Octagenarians

Abstract

Background: The number of candidates older than 69 years awaiting a kidney transplant continues to grow. Outcomes and survival in a Hispanic population are not well described. Purpose: Evaluate the outcome of kidney transplantation in older Hispanic recipients. Methods: 40 recipients 69 to 85 years of age (5 older than 80) (73 ± 4.08) transplanted from 2000 to 2011 were selected as study group. 40 patients 19 to 65 years (46 ± 11.8) from the same period were randomly selected as controls. Demographics, graft and patient survival, renal function, readmissions, length of stay, immunosuppression, polyomavirus (BKV) and cytomegalovirus (CMV) were compared between groups. Results: The majority of transplanted patients in both groups were males (63%, 65%). There were more extended criteria donors (p =0.0001) in the study group. Cadaveric donations were predominant in both groups (83%, 88 %). The mean age of the donor group was 53± 15years for the older recipients and 32 ± 14.9 year in the control group (p =0.001). Hypertension was the most common comorbility in both groups (97 %, 83 %). Diabetes was more frequent in the study group as well as its incidence after transplantation. No significant difference in mean time of dialysis between both groups (p = 0.08). Perioperative mortality in both groups was 0%. There was no significant difference in one and three year graft and patient survival (98%, 100%) (p=0.09). Overall graft failure in the study group was 5%, one acute rejection and one BKV nephritis. Graft failure in controls was 2%, secondary to BKV nephritis (p=0.20). 5-year mortality in the study group was 20% and 5% in the control group (p = 0.08). Infection and cardiovascular disease were the most common causes of death in the study group. At time of death all patients had functioning grafts. There was no significant difference in proteinuria (p =0.33), BKV infection (p=0.71), CMV infection (p=0.16), or re admissions (p=0.37) between groups. Average length of stay was 10 days (SD± 5) for both groups. There was no significant difference in mean creatinine levels between groups at 3, 6 and 12 months after transplant (p=0.45, 0.55, 0.51)Thymoglobulin was used for induction in both groups (88%, 83 %) with an average dose of 4.11±0.97mg/kg in the study group, and 5.14 in controls. Low dose prednisone, tacrolimus and mycophenolate were used for maintenance in 95 % for both groups. There is a significant difference in the average tacrolimus dose at discharge, 1, 3 and 6 months between groups: controls received higher doses. Conclusion: Renal transplantation can be carried out in older patients with good outcomes, low morbidity, and good patient and graft survival, in spite of important co morbidities such as hypertension and diabetes. Immunosuppression should be lower.