SEX DISPARITIES IN KIDNEY TRANSPLANTATION FROM ELDERLY DONORS AND LONG-TERM OUTCOMES IN THE UNITED STATES

Abstract

Introduction: Kidney transplantation offers survival benefit and improved quality of life in end-stage renal disease patients. As the waiting list continues to grow, there has been an increase in the utilization of kidneys from older donors. We examined the sex disparities in graft and patient outcomes of transplant recipients of kidneys from an elderly donor. Methods: We identified 19,820 kidney transplant recipients (KTR) with a donor age ≥ 60 years between January 2000 and December 2016 from the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research data. Using case-mix adjusted logistic regression models, we examined the effects of sex on five-year death-censored graft loss (DCGL) and 5-year recipient survival in KTR of elderly donors. Results: Elderly donors accounted for 7.8% of all donors. The mean donor age was 64±3 years and the mean recipient age was 59±11 years. Higher proportions of elderly donors (54.5%) were women. Only 37.4% of the receipts were women. Overall, one-year DCGL was 7.2%. Five-year DCGL was 15.9% and five-year recipient survival was 79%. In adjusted analyses, women were less likely than men (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.80-0.95, p=0.002) to experience DCGL at five years. In adjusted analyses, women were less likely than men (OR, 0.90; CI, 0.83-0.97, p=0.006) to die at five years after receiving a kidney from an elderly donor. Conclusion: Among KTRs of elderly donors, women are at 12% lower risk of graft failure than men at five years and survive longer after transplantation. Further studies are needed to assess additional factors contributing to sex disparities in graft and recipient survival in KTRs of elderly kidneys.