Trends in Kidney Transplant Outcomes in Older Adults

• Published in: Journal of the American Geriatrics Society (JAGS) 2014-12, Vol.62 (12), p.2235-2242
• Main Authors: McAdams-DeMarco, Mara A., James, Nathan, Salter, Megan L., Walston, Jeremy, Segev, Dorry L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Epidemiology; Female; General aspects; Geriatrics; graft loss; Graft Rejection - mortality; Humans; kidney transplantation; Kidney Transplantation - mortality; Kidneys; Male; Medical sciences; mortality; older adults; Outcome Assessment (Health Care) - trends; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Surgical outcomes; Survival Analysis; Transplants & implants; United States - epidemiology
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.13130

Objectives To estimate mortality and death‐censored graft loss according to year of kidney transplant (KT) between 1990 and 2011. Design Cohort study. Setting The Scientific Registry of Transplant Recipients (SRTR). Participants KT recipients aged 65 and older at the time of transplantation (N = 30,207). Measurements Mortality and death‐censored graft loss ascertained through center report and linkage to Social Security Death Master File and to Medicare. Results Older adults currently account for 18.4% of KT recipients, up from 3.4% in 1990; similar increases were noted for deceased donor (5.4 times percentage increase) and live donor (9.1 times percentage increase) transplants. Current recipients are not only older, but also more likely to be female and African American, have lengthier pretransplant dialysis, have diabetes mellitus or hypertension, and receive marginal kidneys. Mortality for older deceased donor recipients between 2009 and 2011 was 57% lower (hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.33–0.56, P