Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients

Jane J. Long, Jennifer D. Motter, Kyle R. Jackson, Jennifer Chen, Babak J. Orandi, Robert A. Montgomery, Mark D. Stegall, Stanley C. Jordan, Enrico Benedetti, Ty B. Dunn, Lloyd E. Ratner, Sandip Kapur, Ronald P. Pelletier, John P. Roberts, Marc L. Melcher, Pooja Singh, Debra L. Sudan, Marc P. Posner, Jose M. El-Amm, Ron ShapiroMatthew Cooper, Jennifer E. Verbesey, George S. Lipkowitz, Michael A. Rees, Christopher L. Marsh, Bashir R. Sankari, David A. Gerber, Jason R. Wellen, Adel Bozorgzadeh, A. Osama Gaber, Eliot C. Heher, Francis L. Weng, Arjang Djamali, J. Harold Helderman, Beatrice P. Concepcion, Kenneth L. Brayman, Jose Oberholzer, Tomasz Kozlowski, Karina Covarrubias, Allan B. Massie, Mara A. McAdams-DeMarco, Dorry L. Segev, Jacqueline M. Garonzik-Wang

Research output: Contribution to journalArticlepeer-review

Abstract

Older compatible living donor kidney transplant (CLDKT) recipients have higher mortality and death-censored graft failure (DCGF) compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant (ILDKT) recipients who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997, and December 15, 2016, we compared mortality, DCGF, delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age ≥60 years) and 1172 younger (age 18-59 years) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17 542 CLDKT recipients, we used an interaction term to determine whether the relationship between posttransplant outcomes and transplant type (ILDKT vs CLDKT) was modified by age. Overall, older recipients had higher mortality (hazard ratio: 1.632.072.65, P <.001), lower DCGF (hazard ratio: 0.360.530.77, P =.001), and AR (odds ratio: 0.390.540.74, P <.001), and similar DGF (odds ratio: 0.461.032.33, P =.9) and LOS (incidence rate ratio: 0.880.981.10, P = 0.8) compared to younger recipients. The impact of age on mortality (interaction P =.052), DCGF (interaction P =.7), AR interaction P =.2), DGF (interaction P =.9), and LOS (interaction P =.5) were similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.

Original languageEnglish
Pages (from-to)1980-1989
Number of pages10
JournalAmerican Journal of Transplantation
Volume23
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • HLA-incompatible
  • clinical research/practice
  • kidney transplantation
  • living donor
  • older
  • outcomes

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