Surgical complications and risk factors in elderly patients after kidney transplantation: A single-center...

Aging among kidney transplant candidates is associated with increased postoperative morbidity. The determinants of surgical complications and their prognostic impact in elderly recipients remain poorly defined.

This retrospective single-center study included kidney transplantations between 2004 and 2022. In recipients aged ≥ 65 years, factors associated with surgical complications within 3months (classified according to Clavien-Dindo), delayed graft function (DGF), death-censored graft survival, and overall survival were identified using logistic regression and Cox models.

Among 849 kidney transplantations, 190 involved elderly recipients, who had higher rates of surgical complications, DGF, and worse overall survival (all P<0.0001). In elderly recipients, multivariable analysis identified recipient obesity (P=0.047), donor cerebrovascular cause of death (P=0.020), and cold ischemia time (P=0.035) as factors associated with surgical complications; however, these complications did not impact graft or patient survival. Diabetes was associated with an increased risk of DGF (P=0.033), whereas machine perfusion was protective (P=0.049). Graft loss was associated with obesity (P=0.021) and DGF (P=0.005), whereas mortality was associated with recipient age (P=0.016) and donor age (P=0.033).

In elderly recipients, surgical complications are frequent but do not appear to affect overall or graft survival, which are mainly driven by obesity, DGF, and recipient and donor age. Together with the limitations of BMI as a surrogate for body composition, the prominent role of obesity supports the need for comprehensive morphometric assessment in this population.