EPIDEMIOLOGY AND CLINICAL OUTCOMES

I.A. Ghoneim¹, H.Y. Tiong¹, J.D. Schold¹, T. Srinivas¹, C.S. Modlin², D. Goldfarb¹, S.M. Flechner^1
1Glickman Urological And Kidney Institute, Cleveland Clinic Foundation, Cleveland/UNITED STATES OF AMERICA, ²Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland/UNITED STATES OF AMERICA

Body: Introduction: Prior to 2000 only 2 patients over age 70 years had received a kidney transplant at our center. This age limit restriction was based anecdotal reports of excess morbidity and mortalityfor this group. Since 2000, > age 70 represents 3.5% of our recipients, up to 6.3% the past 2 years. The annual mortality of such patients on dialysis exceeds 20%, which drives the desire forrenal transplantation in this population.

Methods: The CCF Unified Transplant Database was queried for all kidney-only transplant recipients age 70 years or older at transplant. There were 49 patients with a mean age of 72.5 (range 70-86)years including 34 males and 15 females. The cause of ESRD included GN 33%; HTN 22%; DM 12%, PKD 6%, Unknown 15%. The Donor Source included DD 67%; LRD 22%: and LUR 10%. The mean BMI was 27 kg/m2.Immunosuppression included mycophenolate mofetil and steroids with a CNI drug in 53.1% or an mTOR in 38.7% of cases. These outcomes were then compared to the SRTR national database during the lastdecade.

Results: The mean FU is 37.7 (range 1-92) months. Kaplan-Meier survivals (%) at 1,3, 5 years, respectively are for Patient Survival (86, 72, and 56). For Graft Survival -uncensored (86, 72, 56) vs.Graft-death censored (97, 94, 88). Among 14 deaths the causes were CV 50%; Infectious 14%; Pulmonary 14%; and Unknown (out of hospital) 21%. One year biopsy confirmed acute rejection was 6%, and themean creatinine was 1.25 mg/dL. There were 3 cases of de novo skin or solid organ cancers. These outcomes are quite similar at our center compared to the national registry. Nationally, the proportionof patients > 70 in the past three years is 6% (an increase from 2.7% in the prior decade). The 1, 3, and 5 yr overall and death censored graft survival rates are (87, 75, 66) and (94, 90, 88),respectively.

Conclusions: Patients over age 70 are seeking the option of kidney transplantation in greater numbers today. Their transplant outcomes are primarily driven by an increased rate of cardiovascularmortality the first 3 years. They exhibit relatively low rates of rejection, infection, and have excellent post transplant renal function. Pretransplant functional capacity and CV status are the bestpredictors of outcome, and therefore careful selection and wait list assessment of their status is essential.

Disclosure: All authors have declared no conflicts of interest.