TOPLINE

Among kidney transplant recipients aged 65 years or older, peripheral artery disease was independently associated with an increased risk for mortality in the first year post-transplant. Chronological age was not independently associated with mortality overall, although recipients older than 75 years showed a trend towards a higher risk for mortality.

METHODOLOGY

• Researchers conducted a retrospective study using registry and healthcare claims data to identify factors associated with mortality and hospitalisation in older kidney transplant recipients.
• They analysed 749 patients (67.4% men) aged 65 years or older who started kidney replacement therapy between 2017 and 2018 and underwent a first kidney transplant before December 2020.
• Patients were categorised into three age groups: 65-69 years (n = 291), 70-74 years (n = 236), and older than 75 years (n = 222); 191 patients received kidney transplant as the first kidney replacement therapy modality, and 104 patients received grafts from living donors.
• The 1-year all-cause mortality and key hospitalisation outcomes — including the initial length of hospital stay, 30-day readmission rates, and cumulative hospital days during the first posttransplant year — were assessed.
• Data on pretransplant cardiovascular-related hospitalisations, outpatient procedures, and specialist consultations performed in the 2 years before waitlist registration and up to the point of active waitlisting were extracted from the healthcare database and analysed.

TAKEAWAY

• The chronological age group did not show an independent association with 1-year mortality rates after kidney transplant overall, although recipients older than 75 years showed a trend towards a higher risk for mortality.
• Peripheral artery disease at the start of kidney replacement therapy was independently associated with an approximately twofold increased risk for mortality during the first posttransplant year (adjusted hazard ratio, 1.97; P = .04). Chronic heart failure, at least two vascular surgery consultations before waitlist registration, and hospitalisation for vascular reasons (excluding dialysis vascular access) were also independently associated with an increased risk for death.
• An age of 70-74 years, chronic respiratory deficiency, and arrhythmia were independently associated with a longer initial hospital stay for the transplant procedure (> 21 days); an age above 75 years and arrhythmia were associated with a longer cumulative hospital stay exceeding 30 days during the first posttransplant year.
• Overall, 56% of patients were readmitted within a month of discharge to home; female sex and longer initial hospitalisation were independent predictors of early readmission.

IN PRACTICE

"Implementing a structured geriatric assessment prior to transplantation could help to identify patients at higher risk, enable timely corrective interventions, and ultimately enhance both clinical outcomes and cost-effectiveness in this vulnerable population," the authors wrote.

SOURCE

This study was led by Elsa Vabret, MD, Pontchaillou Teaching Hospital, University of Rennes, Rennes, France. It was published online on September 23, 2026, in Kidney Diseases.

LIMITATIONS

The retrospective study design and the reliance on administrative billing data may have introduced diagnostic coding inconsistencies and heterogeneity. The study cohort included only patients who were waitlisted and underwent transplant within 3 years of starting dialysis. In addition, clinical data for non-preemptive kidney transplant recipients were collected at dialysis initiation rather than immediately prior to transplant.

DISCLOSURES

This study was funded by the French Biomedicine Agency through a Renal Epidemiology and Information Network research call for proposals. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.