Age-Related Risk After Kidney Transplantation: A Comprehensive Analysis of Infection Burden, Graft Outcomes, and...

Area of Science:

• Nephrology
• Transplantation Immunology
• Geriatric Medicine

Background:

• Kidney transplantation is increasingly performed in elderly individuals.
• Optimized post-transplant care requires understanding age-specific risks.

Purpose of the Study:

• To analyze age-specific risks and outcomes in kidney transplant recipients.
• To identify factors influencing graft outcomes, infection burden, and mortality in different age groups.

Main Methods:

• Analysis of 572 kidney transplant recipients (2012-2023), stratified by age: <40, 40-60, >60 years.
• Median follow-up of 5 years.
• Multivariable Cox models with inverse probability weighting, adjusted for clinical confounders.

Main Results:

• Unadjusted 5-year rates of graft failure, mortality, and infections were higher in older recipients.
• After adjustment, age was independently associated with mortality (HR=6.21, p=0.02) but not overall infection burden or graft loss.
• Older patients showed altered pathogen prevalence (e.g., Pseudomonas aeruginosa, herpesviruses) and higher infection-related morbidity.
• Early post-transplant infection burden predicted graft failure (HR=1.16, p<0.01).

Conclusions:

• Age alone is not a primary predictor of adverse kidney transplant outcomes.
• Post-transplant care for elderly recipients should prioritize early infection control and pathogen-targeted surveillance.
• Focusing on infection management in the critical first year post-transplant is crucial for graft survival.