In older adults (≥65), access to and outcomes following kidney transplantation (KT) have improved over the past 3 decades. It is unknown if there were parallel trends in re-KT. We characterized the trends, changing landscape, and outcomes of re-KT in older adults.
Among the 44,149 older kidney-only recipients (1995–2016) in the Scientific Registry of Transplant Recipients, we identified 1743 who underwent re-KT. We analyzed trends and outcomes (mortality, death-censored graft failure [DCGF]) by eras (1995–2002, 2003–2014, and 2015–2016) that were defined by changes to the expanded criteria donors and Kidney Donor Profile Index policies.
Among all older kidney-only recipients during 1995–2002, 2003–2014, 2015–2016 the proportion that were re-KTs increased from 2.7% to 4.2% to 5.7%, P < 0.001, respectively. Median age at re-KT (67–68–68, P = 0.04), years on dialysis after graft failure (1.4–1.5–2.2, P = 0.003), donor age (40.0–43.0–43.5, P = 0.04), proportion with panel reactive antibody 80–100 (22.0%–32.7%–48.7%, P < 0.001), and donation after circulatory death (1.1%–13.4%–19.5%, P < 0.001) have increased. Despite this, the 3-y cumulative incidence for mortality (22.3%–19.1%–11.5%, P = 0.002) and DCGF (13.3%–10.0%–5.1%, P = 0.01) decreased over time. Compared with deceased donor retransplant recipients during 1995–2002, those during 2003–2014 and 2015–2016 had lower mortality hazard (aHR = 0.78, 95% confidence interval, 0.63-0.86 and aHR = 0.55, 95% confidence interval, 0.35-0.86, respectively). These declines were noted but not significant for DCGF and in living donor re-KTs.
In older retransplant recipients, outcomes have improved significantly over time despite higher risk profiles; yet they represent a fraction of the KTs performed. Our results support increasing access to re-KT in older adults; however, approaches to guide the selection and management in those with graft failure need to be explored.