Clinical Benefit and Remaining Risks of Kidney Transplantation in Older Patients: A Matched Comparison With CKD Patients

Background: Although kidney transplantation (KT) is associated with survival benefit compared with dialysis, even in older patients with end-stage kidney disease (ESKD), the magnitude of this benefit, non-mortality outcomes, and residual complications remain unclear. Comparisons with patients diagnosed with non-dialysis-dependent chronic kidney disease (CKD) can better clarify these issues. Methods: Older KT recipients and patients with CKD were enrolled from a prospective nationwide database (N = 817) and the National Health Insurance Service-Senior Cohort Database (N = 14,185), respectively. A 1:1 matching was performed. All-cause mortality, cardiovascular events, progression to ESKD, infection-related hospitalizations, and cancer were compared. Results: Each group comprised 802 matched patients; 115 deaths, 25 cardiovascular events, 40 ESKD events, and 288 infection-related hospitalizations occurred over a median follow-up period of 88 months. Cumulative incidences of mortality and cardiovascular events were comparable between groups, whereas progression to ESKD and infection-related hospitalizations were higher in older KT recipients than in patients with CKD. In multivariable Cox analysis, older KT recipients had similar risks of all-cause mortality (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.33–1.01) and cardiovascular events (1.31, 0.42–4.05) to older patients with CKD but had increased risks of progression to ESKD (3.51, 1.07–11.5) and infection-related hospitalizations (3.91, 2.66–5.74). HR of incident cancer was similar between groups (1.35, 0.75–2.46). Conclusions: Older KT recipients did not demonstrate increased risks of all-cause mortality, cardiovascular events, or incident cancer compared with the matched CKD population but had higher risks of kidney failure and infection-related hospitalization.