FC 111: A Comorbidity Index and Pretransplant Physical Status Predict Survival in Older Kidney Transplant Recipients

BACKGROUND AND AIMS

Regardless of age, kidney transplantation (KT) is considered the optimal treatment for patients with end-stage kidney disease (ESKD). In the increasing elderly ESKD population, KT should be reserved for carefully selected candidates who are expected to experience favorable outcomes. We aimed to prospectively evaluate pre-transplant recipient factors that may predict post-transplant patient survival and can eventually guide therapeutic decisions in elderly with ESKD.

METHOD

Recipient factors were evaluated in KT candidates aged ≥65 years, who were enlisted for KT between January 2013 and November 2016 at the Norwegian national transplant centre. Pretransplant comorbidity was assessed at waitlisting, according to the Liu Comorbidity Index (LCI). Self-reported health-related quality of life was assessed using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF). The Cox proportional hazard regression was used to evaluate predictors of patient survival.

RESULTS

We included 289 waitlisted candidates, of whom 192 received a deceased brain-dead donor kidney. Mean age at KT was 72 (4.1) years, 133 (69%) were male, 47 (24%) were transplanted preemptively and 80% received an expanded criteria donor organ. During a median observation time of 4.6 (3.2–6.3) years post-KT, 66 recipients died. LCI ≤ 3 was observed in 136 recipients (71%), between 4–6 in 39 recipients (20%) and 17 recipients (9%) had LCI ≥ 7. Elevated LCI ≥ 4 predicted poor patient survival, and was associated with a 2.2-times increase in mortality risk (Figure 1). In recipients with LCI ≥ 4, dialysis ≥2 years comprised a 2.5-fold higher mortality risk, compared with recipients on dialysis ≤2 years (Figure 2). Self-reported pretransplant physical function was also proven to be a significant positive predictor of survival, with scores ≤60 being associated with a 2-fold increase in mortality risk.

CONCLUSION

The implementation of LCI and a physical function score during the evaluation of older kidney transplant candidates may improve the selection and thereby optimize post-transplant outcomes.

MO985: Physical Function Trajectories Predict Patient Survival in Older Recipients of Deceased Donor Kidneys

BACKGROUND AND AIMS

Health-related quality of life (HRQOL) outcomes have been positively associated with patient survival after kidney transplantation (KT). In older recipients, poor HRQOL may indicate risk for clinical deterioration. We aimed to prospectively evaluate if, in older recipients of deceased brain-dead donor (DBD) kidneys, changes in HRQOL during the first year post-transplantation differed between survivor and non-survivors.

METHOD

KT candidates aged ≥65 years who were enlisted between January 2013 and November 2016 at the Norwegian national transplant center and received a deceased brain-dead donor (DBD) kidney were included. HRQOL was assessed using the Kidney Disease Quality of Life Short Form, version 1.3. HRQOL outcomes were collected prior to KT, at 10 weeks, 6 months and 12 months post-KT. A mixed-effect linear regression model was used to examine the development of HRQOL during the first year post-KT in survivors versus non-survivors. Longitudinal HRQOL trajectories were identified using a group-based trajectory modelling. A Cox proportional hazard regression was used to investigate the association of longitudinal HRQOL trajectories for each domain with patient survival.

RESULTS

We included 289 waitlisted candidates, of whom 192 received a DBD kidney. Mean age at KT was 72 (4.1) years, 133 (69%) were males, 47 (24%) were transplanted preemptively and 80% received an expanded criteria donor organ. During a median observation time of 4.6 (3.2, 6.3) years post-KT, 66 recipients died. In survivors, all the generic and kidney-specific HRQOL domains substantially improved during the first year post-KT, whereas HRQOL deteriorated in non-survivors (Figure 1). Three developmental trajectories, describing poor, fair and good outcomes were identified for most of the HRQOL domains. Recipients perceiving poor physical development during the first post-transplant year had a 2.5 higher mortality risk, while recipients with fair physical development had 1.4 increased mortality risk, compared with recipients with good physically development (Figure 2).

CONCLUSION

In elderly kidney transplant recipients, poor post-transplant physical function trajectory may indicate impaired survival. The systematic HRQOL monitoring following KT is warranted to identify high-risk patients and guide therapeutic decisions.

MO923PREDICTING POST-TRANSPLANT HRQOL TO OPTIMIZE OUTCOMES IN OLDER KIDNEY TRANSPLANT RECIPIENTS

Background and Aims

Kidney transplantation (KT) is the optimal treatment for older patients in need for kidney replacement therapy, with favorable outcomes both on survival, and health-related quality of life (HRQoL). Given the current organ scarcity, allocation of transplants should prioritize patients who are expected to benefit most from KT and identifying reliable predictors of post-transplant HRQoL outcomes is essential to optimize the selection process.

Method

Patients ≥ 65 years, who were enlisted for KT between January 2013 and November 2016 at the Norwegian national transplant center, were asked to participate. Self-reported HRQoL was assessed using the Kidney-Disease Quality of Life Short Form version 1.3 (KDQOL-SF) survey. Pre-transplant comorbidity was assessed by the Liu comorbidity index (LCI). Linear mixed-effect models were used to detect HRQoL changes over time (pre-KT, at -6, -12 and -36 months post-KT), and to identify pre-transplant predictors of post-transplant outcomes.

Results

By November 2020, 220 (76%) out of 289 enrolled participants, were transplanted. The mean age at KT was 71.8 (4.1) years, 154 (70%) were males, 57 (26%) were transplanted pre-emptively and 30 (13.6%) received a transplant from a living donor.

Longer dialysis vintage was independently associated with impaired physical function post-transplantion (Figure 1). Pre-transplant LCI score ≥ 7 consistently predicted poorer HRQoL outcomes at baseline and after 3-years, compared with LCI score < 7 (Figure 2). At 3- years post-transplant, increasing LCI score was lineary associated with decreasing SF-36 scores. Recipients on dialysis for ≥ 1 year with LCI ≥ 7 experienced the worst outcomes, with a marked and sustained post-transplant physical deterioration (Figure 3).

Conclusion

Older wait-listed candidates either on dialysis for >1 year or with elevated pre-transplant LCI are at high risk for impaired HRQoL post-transplant outcomes and should be re-evaluated with respect to transplantability on a regular basis. The identification of criteria to optimize the selection of older transplant candidates should be the scope of future studies