Renal Transplantation in Older Patients: Distinct Survival Advantage With a Higher Infection Risk.: Abstract# D2473

Introduction: There is an annual increase in the number of elderly patients with end-stage renal failure (ESRF) requiring renal replacement (RRT) therapy. In this cohort, renal transplantation remains the optimal form of RRT with confirmed evidence for enhanced survival benefit. However, clinician reticence persists in light of scarce allograft resource and concerns regarding potential complications, especially due to the burden of immunosuppressive load. We aimed to compare survival and transplant risk in elderly patients post transplantation with a comparable group on the waiting list. Methods: Retrospective analysis was performed of older patients (>60 years old), on dialysis for ESRF, who underwent kidney transplantation (n=164) and those remaining on the waiting list (n=400) as a comparable control (May 2007 - Nov 2012.) The primary endpoint was patient mortality. Potential confounding factors (cardiovascular status and other co-morbidities, age, gender, time on dialysis and time on waiting list) were analysed. The incidence of opportunistic infections in the transplanted group was also analysed (CMV, BK/JC and EBV) as a secondary endpoint. Results: The overall mortality in the transplant group was 4.3% (7/164) which was significantly less than the mortality in the waiting list group (10.5%; 42/400; p=0.02, Fisher's exact test). The 30-day and 1-year survival in the transplant group was 99.4% (163/164) and 96.8% (153/158) respectively, which was not significantly different from the waiting list group (100% and 97.8%; p=NS, Fisher's exact test). However, 5-year survival was significantly better in the transplant group at 97% (27/30) versus 43.8% (32/73) in the waiting list group (p=0.0001, Fisher's exact test). There was no difference in any potential confounding factors or medical co-morbidities. Opportunistic infection rate in the transplant group was 40.1% (CMV- 23%, BK/JC- 3.7%, EBV- 3%, Recurrent UTI's- 11%). Conclusions: Renal transplantation offers a significant survival advantage over dialysis as renal replacement therapy in elderly patients with ESRF who are eligible and fit for transplantation. However, the high rates of opportunistic infections in the elderly transplanted patients may suggest an element of over-immunosuppression in this cohort of patients necessitating consideration of a tailored regimen to improve outcomes.