Predictors of Early Posttransplant Complications and Clinical Outcomes in Kidney Transplant Recipients Aged ≥65 y

Older adults represent a growing proportion of kidney transplant (KT) recipients, but early posttransplant morbidity remains substantial. We aimed to identify pretransplant factors associated with a complicated early posttransplant course in recipients aged ≥65 y and to assess its impact on subsequent outcomes.

We conducted a single-center retrospective cohort study of KT recipients aged ≥65 y. The primary in-hospital composite outcome comprised length of stay >15 d, infectious complications, delayed graft function, primary nonfunction, or in-hospital death. Patients were classified as complicated or noncomplicated. Univariable and multivariable logistic regression identified predictors of the composite outcome. Postdischarge outcomes included death, all-cause hospitalization, clinically relevant infections, surgical/urological complications, and kidney function at last follow-up. Clinical events were assessed by survival analyses and kidney function by adjusted models.

Ninety-three recipients were included (median age 68.5 y; 40% aged >70 y); 61 experienced a complicated in-hospital course. In multivariable analysis, longer dialysis vintage and donor hypertension were associated with higher odds of the composite outcome, whereas preemptive transplantation and living donation were associated with lower odds. During a median follow-up of 29.8 mo, patients with a complicated early course had numerically higher rates of the composite clinical endpoint, hospitalization, and infection, but these differences were not statistically significant in Cox regression analyses. Crude estimated glomerular filtration rate was lower among patients with a complicated course; however, kidney function was comparable after adjustment for discharge estimated glomerular filtration rate.

Among KT recipients aged ≥65 y, longer dialysis exposure and donor hypertension were key determinants of a complicated early posttransplant course, while preemptive and living-donor transplantation appeared protective. Early complications were associated with numerically higher postdischarge event rates but were not independently associated with worse subsequent outcomes. These findings support minimizing dialysis exposure, careful donor selection, and close perioperative management in older KT recipients.