S SO 1,2, AU E1,2,3, LEE V1,2, LIM W4,5, WONG G1,2,3
1Department of Renal Medicine and Transplantation, Westmead Hospital, Westmead, Australia, 2The University of Sydney, Sydney, Australia, 3Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 4Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia, 5Medical School, University of Western Australia, Perth, Australia
Aim: To determine the factors associated with waitlisting and deceased donor kidney transplantation in a cohort of older patients treated with dialysis.
Background: Older patients have higher incidence of kidney failure, but lower rates of transplantation compared to their younger counterparts.
Methods: Multivariable Cox regression modelling was used to determine the factors associated with waitlisting and subsequent transplantation in a cohort of patients who commenced dialysis aged ≥65 years between June 2006-December 2016.
Results: Of the 17,704 older patients, 612 (3.5%) were listed and followed for 3227 patient-years. Of these, 136 (22.2%) died and 387 (63.2%) received a deceased donor kidney transplant. Median time from waitlisting to transplant was 5.3 (IQR 2.0-16.7) months. Factors associated with increased likelihood of waitlisting [adjusted HR (95%)] were peritoneal dialysis as initial kidney replacement therapy [1.25 (1.05-1.48), recent era of dialysis commencement [1.15 (1.13-1.18)] and patients residing in SA [1.52 (1.12-2.06)]. Those with peripheral vascular disease (PVD), older age (per year increase) and diabetes mellitus were less likely to be listed [0.76 (0.58-0.99), 0.97 (0.93-1.00), 0.76 (0.57-0.99)]. Once on the list, higher SES [1.69 (1.20-2.39) – highest compared to lowest quintile], recent era of listing [1.19 (1.14-1.24)], longer duration on dialysis (per month) [1.02 (1.02-1.03)] and had PVD [1.43 (1.01-2.01)] were each associated with a higher probability of receiving a deceased donor transplant. Older patients residing in NSW and Vic were less likely to receive a transplant compared to the other States [0.36 (0.26-0.49), 0.36 (0.27-0.49].
Conclusions: Apart from known factors such as comorbidities that govern transplant candidacy, the observed disparity in access to deceased donor kidney transplantation in older dialysis patients are driven by socioeconomic and geographical factors.
Dr Sarah So is a nephrologist and final-year palliative care advanced trainee, trained primarily in Western and South-western Sydney. Her areas of interest are in symptom control and quality of life in kidney disease managed without dialysis, and management of chronic kidney disease in the elderly.