Should patients older than 65 years be offered a second kidney transplant?
BACKGROUND
Age and number of recipients in need of kidney re-transplantation are increasing. Re-transplantation practices and outcomes in elderly recipients are not previously explored. We aimed to retrospectively evaluate the outcomes of recipients 65 years and older receiving their second deceased donor allograft.


METHODS
The study was designed as a retrospective registry based study. All recipients 65 years or older who received a deceased donor kidney transplant at Oslo University Hospital between 2000 and 2014 were included in the study. Survival outcomes were compared between recipients of first (TX1) and second (TX2) allograft. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazard models with patient survival, uncensored graft survival and death-censored graft survival as outcomes in the analyses.


RESULTS
Seven hundred and thirty-tree recipients > 65 years received a first (n = 687) or second (n = 46) deceased donor kidney transplant. Five years uncensored graft survival rates were 64% in TX 2 and 67% in TX 1 (P=﻿ 0.789). Estimated five years graft survival rates censored for death with functioning graft were 88% in TX2 and 90% in TX1 (P=0.475). Adjusted hazard ratio for uncensored graft loss (TX2 vs. TX1) was 1.24 (95% CI 0.77 - 2.00). Adjusted hazard ratio for graft loss censored for death with functioning graft (TX2 vs. TX1) was 1.70 (0.72-4.02).


CONCLUSIONS
Older recipients of second transplants have outcomes that are comparable to the outcomes of age-matched first transplant recipients, and far better than previously documented for older transplant candidates remaining on dialysis treatment. Advanced age by itself should not be a contraindication for re-transplantation. Best results are achieved with short time on dialysis before re-transplantation.
['Heldal|Kristian|K|http://orcid.org/0000-0003-4427-9528', 'Hartmann|Anders|A|', 'Lønning|Kjersti|K|', 'Leivestad|Torbjørn|T|', 'Reisæter|Anna V|AV|', 'Line|Pål-Dag|PD|', 'Holdaas|Hallvard|H|', 'Midtvedt|Karsten|K|']
D017677:Age Distribution D000368:Aged D000369:Aged, 80 and over D004608:Eligibility Determination D006084:Graft Rejection D006085:Graft Survival D006801:Humans D015994:Incidence D007676:Kidney Failure, Chronic D016030:Kidney Transplantation D008297:Male D009664:Norway D018579:Patient Selection D012042:Registries D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate D014019:Tissue Donors D016896:Treatment Outcome
Kidney transplantation Elderly Graft survival Chronic renal failure Epidemiology