Deceased-donor kidney transplantation in older adults: long-term survival and age-based comparison.

Abstract

Introduction: Kidney transplantation offers prolonged survival for patients with advanced kidney disease. However, older adults remain underrepresented due to uncertainty regarding post-transplant outcomes.

Materials and Methods: A retrospective cohort study was conducted at the Armed Forces Specialties Hospital No. 1 in Quito, Ecuador, using secondary data from the National Institute for the Donation and Transplantation of Organs, Tissues, and Cells (INDOT). From a total of 109 transplant episodes, the first transplant performed on each of 102 unique patients was selected for analysis. Overall survival was estimated from the time of transplantation until death or the last follow-up visit. Patients aged over 64 years at the time of entry onto the National Single Waiting List were compared with those aged 64 years or younger using Kaplan–Meier analysis, the log-rank test, and Cox regression.

Results: The study included 61 men (59.8%) and 41 women (40.2%); the median age at transplantation was 51 years (IQR: 36–61). The group aged over 64 years comprised 13 patients, 11 of whom were men (84.6%); their median age was 68 years (IQR: 66–69; range: 65–71), and 5 deaths (38.5%) occurred in this group. During a mean follow-up period of 7.52 years, 17 deaths were recorded. Overall survival at 9 years was 79.5% (95% CI: 67.0–87.7). Overall survival was 81.2% (95% CI: 67.7–89.5) for patients aged 64 years or younger and 67.3% (95% CI: 27.3–88.6) for those aged over 64 years (p=0.016). Age over 64 years was associated with higher mortality (HR, 3.37; 95% CI, 1.18–9.60; p=0.023).

Conclusions: Despite the higher risk of mortality, approximately two-thirds of older recipients remained alive at 9 years, supporting the view that chronological age alone should not preclude access to kidney transplantation.