Shaifali Sandal1,2, JiYoon B Ahn3, Marcelo Cantarovich1,2, Nadia M Chu3,4, Dorry L Segev3,4, Mara A McAdams-DeMarco3,4. 1. Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada. 2. Research Institute of the McGill University Health Centre, Montreal, QC, Canada. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abstract
BACKGROUND: In older adults (≥65), access to and outcomes following kidney transplantation (KT) have improved over the past 3 decades. It is unknown if there were parallel trends in re-KT. We characterized the trends, changing landscape, and outcomes of re-KT in older adults. METHODS: Among the 44,149 older kidney-only recipients (1995-2016) in the Scientific Registry of Transplant Recipients, we identified 1743 who underwent re-KT. We analyzed trends and outcomes (mortality, death-censored graft failure [DCGF]) by eras (1995-2002, 2003-2014, and 2015-2016) that were defined by changes to the expanded criteria donors and Kidney Donor Profile Index policies. RESULTS: Among all older kidney-only recipients during 1995-2002, 2003-2014, 2015-2016 the proportion that were re-KTs increased from 2.7% to 4.2% to 5.7%, P < 0.001, respectively. Median age at re-KT (67-68-68, P = 0.04), years on dialysis after graft failure (1.4-1.5-2.2, P = 0.003), donor age (40.0-43.0-43.5, P = 0.04), proportion with panel reactive antibody 80-100 (22.0%-32.7%-48.7%, P < 0.001), and donation after circulatory death (1.1%-13.4%-19.5%, P < 0.001) have increased. Despite this, the 3-y cumulative incidence for mortality (22.3%-19.1%-11.5%, P = 0.002) and DCGF (13.3%-10.0%-5.1%, P = 0.01) decreased over time. Compared with deceased donor retransplant recipients during 1995-2002, those during 2003-2014 and 2015-2016 had lower mortality hazard (aHR = 0.78, 95% confidence interval, 0.63-0.86 and aHR = 0.55, 95% confidence interval, 0.35-0.86, respectively). These declines were noted but not significant for DCGF and in living donor re-KTs. CONCLUSIONS: In older retransplant recipients, outcomes have improved significantly over time despite higher risk profiles; yet they represent a fraction of the KTs performed. Our results support increasing access to re-KT in older adults; however, approaches to guide the selection and management in those with graft failure need to be explored.
BACKGROUND: In older adults (≥65), access to and outcomes following kidney transplantation (KT) have improved over the past 3 decades. It is unknown if there were parallel trends in re-KT. We characterized the trends, changing landscape, and outcomes of re-KT in older adults. METHODS: Among the 44,149 older kidney-only recipients (1995-2016) in the Scientific Registry of Transplant Recipients, we identified 1743 who underwent re-KT. We analyzed trends and outcomes (mortality, death-censored graft failure [DCGF]) by eras (1995-2002, 2003-2014, and 2015-2016) that were defined by changes to the expanded criteria donors and Kidney Donor Profile Index policies. RESULTS: Among all older kidney-only recipients during 1995-2002, 2003-2014, 2015-2016 the proportion that were re-KTs increased from 2.7% to 4.2% to 5.7%, P < 0.001, respectively. Median age at re-KT (67-68-68, P = 0.04), years on dialysis after graft failure (1.4-1.5-2.2, P = 0.003), donor age (40.0-43.0-43.5, P = 0.04), proportion with panel reactive antibody 80-100 (22.0%-32.7%-48.7%, P < 0.001), and donation after circulatory death (1.1%-13.4%-19.5%, P < 0.001) have increased. Despite this, the 3-y cumulative incidence for mortality (22.3%-19.1%-11.5%, P = 0.002) and DCGF (13.3%-10.0%-5.1%, P = 0.01) decreased over time. Compared with deceased donor retransplant recipients during 1995-2002, those during 2003-2014 and 2015-2016 had lower mortality hazard (aHR = 0.78, 95% confidence interval, 0.63-0.86 and aHR = 0.55, 95% confidence interval, 0.35-0.86, respectively). These declines were noted but not significant for DCGF and in living donor re-KTs. CONCLUSIONS: In older retransplant recipients, outcomes have improved significantly over time despite higher risk profiles; yet they represent a fraction of the KTs performed. Our results support increasing access to re-KT in older adults; however, approaches to guide the selection and management in those with graft failure need to be explored.
Authors: J Sellarés; D G de Freitas; M Mengel; J Reeve; G Einecke; B Sis; L G Hidalgo; K Famulski; A Matas; P F Halloran Journal: Am J Transplant Date: 2011-11-14 Impact factor: 8.086
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Authors: M L Nicholson; M S Metcalfe; S A White; J R Waller; T M Doughman; T Horsburgh; J Feehally; S J Carr; P S Veitch Journal: Kidney Int Date: 2000-12 Impact factor: 10.612
Authors: Megan L Salter; Mara A McAdams-Demarco; Andrew Law; Rebecca J Kamil; Lucy A Meoni; Bernard G Jaar; Stephen M Sozio; Wen Hong Linda Kao; Rulan S Parekh; Dorry L Segev Journal: J Am Geriatr Soc Date: 2014-05-06 Impact factor: 5.562
Authors: Sarah E Van Pilsum Rasmussen; Fatima Warsame; Ann K Eno; Hao Ying; Karina Covarrubias; Christine E Haugen; Nadia M Chu; Deidra C Crews; Meera N Harhay; Nancy L Schoenborn; Dorry L Segev; Mara A McAdams-DeMarco Journal: Transplantation Date: 2020-03 Impact factor: 5.385
Authors: Shaifali Sandal; Kathleen Charlebois; Julio F Fiore; David Kenneth Wright; Marie-Chantal Fortin; Liane S Feldman; Ahsan Alam; Catherine Weber Journal: Can J Kidney Health Dis Date: 2019-02-13
Authors: Shaifali Sandal; JiYoon B Ahn; Dorry L Segev; Marcelo Cantarovich; Mara A McAdams-DeMarco Journal: Am J Transplant Date: 2021-08-23 Impact factor: 8.086