Korean J Transplant.  2023 Nov;37(Suppl 1):S161. 10.4285/ATW2023.F-7465.

Clinical outcomes of retransplantation in elderly kidney recipients

• Lee H
• Yang CW
• Chung BH

• KMID: 2551781
• DOI: http://doi.org/10.4285/ATW2023.F-7465

Abstract

Background
There has been an increase in demand for kidney retransplantation. Key issues in retransplantation are the surgical and immunological challenges. Moreover, older age at organ transplantation is associated with an increased risk of infection and malignancy. In this context, we investigated the clinical outcomes of elderly patients who underwent multiple kidney transplantations (KTs).
Methods
Between January 2010 and December 2019, a total of 1,459 KTs were performed at Seoul St. Mary’s Hospital. Of these, we included 162 patients who underwent a second or third KT. They were divided into two groups based on the recipients age at the time of KT (60 or <60 years); elderly (n=21) and young (n=141). We compared the allograft outcomes and complications.
Results
Pretransplant immunologic risk factors, such as crossmatch positivity, number of human leukocyte antigen mismatches, and ABO incompatibility, did not differ between the groups. The incidence and cumulative rate of biopsy-proven acute rejection (BPAR), development of de novo donor-specific antibodies, and graft failure were also similar between the groups (BPAR, log-rank P=0.17; graft failure, log-rank P=0.63). In the elderly group, there were no cases of primary nonfunction compared to the young group, which had two cases. Patient mortality was higher in the elderly group (log-rank P=0.03), and 75% of the deaths were caused by infection, compared to the young group where 12.5% of deaths were related to infection.
Conclusions
In retransplantation in elderly recipients, graft survival and acute rejection-free survival were not inferior to those of young recipients. Immediate surgical complications were lower in elderly recipients. However, infection-related deaths were increased in elderly recipients. These results indicate that repeat KT in elderly recipients is a reasonable choice when done with caution to avoid overimmunosuppression.