Observational study of risk factors associated with clinical outcome among elderly kidney transplant recipients in Sweden – a decade of follow‐up

Summary Kidney transplantation (Ktx) in elderly has become increasingly accepted worldwide despite their higher burden of comorbidities. We investigated important risk factors affecting long‐term patient and graft survival. We included all ( n  = 747) Ktx patients >60 years from 2000 to 2012 in Sweden. Patients were age‐stratified, 60–64, 65–69 and >70 years. Follow‐up time was up to 10 years (median 7.9 years, 75% percentile >10 years). Primary outcome was 10‐year patient survival in age‐stratified groups. Secondary outcomes were 5‐year patient and graft survival in age‐stratified groups and the impact of risk factors including Charlson comorbidity index (CCI) on patient and graft survival. Mortality was higher in patients >70 years, after 10 years (HR 1.94; 95% CI 1.24–3.04; P  = 0.004). Males had a higher 10‐year risk of death (HR 1.39; CI 95% 1.04–1.86; P  = 0.024). Five‐year patient survival did not differ between age groups. In multivariate Cox analysis ( n  = 500), hazard ratio for 10‐year mortality was 4.6 in patients with CCI ≥7 vs. <4 (95% CI 2.42–8.62; P  = 0.0001). Higher CCI identified ESKD patients with 4.6 times higher risk of death after Ktx. We suggest that this index should be used as a part of the preoperative evaluation in elderly.