RENAL TRANSPLANTATION IN ELDERLY PATIENTS AGED 65 YEARS AND OLDER: SHORT-TERM CLINICAL OUTCOMES FROM A SINGLE CENTER EXPERIENCE

 

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RENAL TRANSPLANTATION IN ELDERLY PATIENTS AGED 65 YEARS AND OLDER: SHORT-TERM CLINICAL OUTCOMES FROM A SINGLE CENTER EXPERIENCE

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Kirill
Komissarov
Olga Krasko olga.krasko.ok@gmail.com United Institute of Informatics Problems of the National Academy of Science of Belarus Department of Informatics Minsk Belarus -
Aliaksei Yakimchuk alexyakweb@gmail.com Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology Department of Anesthesiology Minsk Belarus -
Tatsiana Сhabatarova tchebotarjowa@mail.ru Minsk Scientific and Practical Center for Surgery Transplantology and Hematology Department of nephrology Minsk Belarus -
Kirill Komissarov kirill_ka@tut.by Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology Department of nephrology Minsk Belarus *
Aleh Aleh oleg_kalachik@hotmail.com Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology Department of Kidney Transplantation Minsk Belarus -
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Age per se should not be a contraindication to kidney transplantation. The first studies have shown a benefit for the survival of elderly eligible patients getting a kidney transplant compared to be maintained on the waiting list. However, more recent data suggest that this benefit is not as constant, notably with a significant early mortality period. In this retrospective single-center study we evaluated the short-term outcome after kidney transplant in recipients older than 65 years in terms of patient and graft survival and causes of death. 

From 2014 to 2024, 123 consecutive transplanted recipients older than 65 years were included. Recipient characteristics were analyzed: sex, age, cause of CKD, duration of dialysis, time in waiting list. There were other parameters cold and warm ischemia times, number of mismatches, delayed graft function, biopsy-proven acute rejection, and causes of death and number of rejections in the first 3 months after transplantation. Induction immunosuppressive therapy was performed with basiliximab or thymoglobulin. Baseline triple immunosuppression included calcineurin inhibitor, antimetabolite, and steroids. 

The median age was 68 years (interquartile range: 66–71), and the percentage of males was 54.4%. The main causes of chronic kidney disease (CKD) were chronic glomerulonephritis (29.3%), arterial hypertension (17.9%), and diabetes mellitus (13.8%). Overall mortality in the first three months was 27.6%. Causes of death included infections (87%), cardiovascular disease (10%), and cerebrovascular disease (3%). At three months, overall graft survival was 89%. A comparative analysis between the group of survivors and those who died within the first three months after transplantation indicated that the duration of dialysis was a statistically significant factor associated with an unfavorable outcome (p=0.001), while a greater number of mismatches (greater than 2) determined the risk of death (p=0.059).

In our single-center study, kidney transplantation in patients older than 65 years was feasible, with a total mortality rate of 27.6% at three months after the operation. Infection was the main cause of unfavorable outcomes. Additionally, the duration of dialysis before kidney transplantation was associated with patient mortality following the operation.

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