Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients

Jane J. Long; Jennifer D. Motter; Kyle R. Jackson; Jennifer Chen; Babak J. Orandi; Robert A. Montgomery; Mark D. Stegall; Stanley C. Jordan; Enrico Benedetti; Ty B. Dunn; Lloyd E. Ratner; Sandip Kapur; Ronald P. Pelletier; John P. Roberts; Marc L. Melcher; Pooja Singh; Debra L. Sudan; Marc P. Posner; Jose M. El-Amm; Ron Shapiro; Matthew Cooper; Jennifer E. Verbesey; George S. Lipkowitz; Michael A. Rees; Christopher L. Marsh; Bashir R. Sankari; David A. Gerber; Jason R. Wellen; Adel Bozorgzadeh; A. Osama Gaber; Eliot C. Heher; Francis L. Weng; Arjang Djamali; J. Harold Helderman; Beatrice P. Concepcion; Kenneth L. Brayman; Jose Oberholzer; Tomasz Kozlowski; Karina Covarrubias; Allan B. Massie; Mara A. McAdams-DeMarco; Dorry L. Segev; Jacqueline M. Garonzik-Wang

doi:10.1016/j.ajt.2023.09.010

Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients

Jane J. Long, Jennifer D. Motter, Kyle R. Jackson, Jennifer Chen, Babak J. Orandi, Robert A. Montgomery, Mark D. Stegall, Stanley C. Jordan, Enrico Benedetti, Ty B. Dunn, Lloyd E. Ratner, Sandip Kapur, Ronald P. Pelletier, John P. Roberts, Marc L. Melcher, Pooja Singh, Debra L. Sudan, Marc P. Posner, Jose M. El-Amm, Ron ShapiroMatthew Cooper, Jennifer E. Verbesey, George S. Lipkowitz, Michael A. Rees, Christopher L. Marsh, Bashir R. Sankari, David A. Gerber, Jason R. Wellen, Adel Bozorgzadeh, A. Osama Gaber, Eliot C. Heher, Francis L. Weng, Arjang Djamali, J. Harold Helderman, Beatrice P. Concepcion, Kenneth L. Brayman, Jose Oberholzer, Tomasz Kozlowski, Karina Covarrubias, Allan B. Massie, Mara A. McAdams-DeMarco, Dorry L. Segev, Jacqueline M. Garonzik-Wang

Research output: Contribution to journal › Article › peer-review

Abstract

Older compatible living donor kidney transplant (CLDKT) recipients have higher mortality and death-censored graft failure (DCGF) compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant (ILDKT) recipients who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997, and December 15, 2016, we compared mortality, DCGF, delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age ≥60 years) and 1172 younger (age 18-59 years) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17 542 CLDKT recipients, we used an interaction term to determine whether the relationship between posttransplant outcomes and transplant type (ILDKT vs CLDKT) was modified by age. Overall, older recipients had higher mortality (hazard ratio: _1.632.07_2.65, P <.001), lower DCGF (hazard ratio: _0.360.53_0.77, P =.001), and AR (odds ratio: _0.390.54_0.74, P <.001), and similar DGF (odds ratio: _0.461.03_2.33, P =.9) and LOS (incidence rate ratio: _0.880.98_1.10, P = 0.8) compared to younger recipients. The impact of age on mortality (interaction P =.052), DCGF (interaction P =.7), AR interaction P =.2), DGF (interaction P =.9), and LOS (interaction P =.5) were similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.

Original language	English (US)
Pages (from-to)	1980-1989
Number of pages	10
Journal	American Journal of Transplantation
Volume	23
Issue number	12
DOIs	https://doi.org/10.1016/j.ajt.2023.09.010
State	Published - Dec 2023

Keywords

HLA-incompatible
clinical research/practice
kidney transplantation
living donor
older
outcomes

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

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10.1016/j.ajt.2023.09.010

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Long, J. J., Motter, J. D., Jackson, K. R., Chen, J., Orandi, B. J., Montgomery, R. A., Stegall, M. D., Jordan, S. C., Benedetti, E., Dunn, T. B., Ratner, L. E., Kapur, S., Pelletier, R. P., Roberts, J. P., Melcher, M. L., Singh, P., Sudan, D. L., Posner, M. P., El-Amm, J. M., ... Garonzik-Wang, J. M. (2023). Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients. American Journal of Transplantation, 23(12), 1980-1989. https://doi.org/10.1016/j.ajt.2023.09.010

Long, JJ, Motter, JD, Jackson, KR, Chen, J, Orandi, BJ, Montgomery, RA, Stegall, MD, Jordan, SC, Benedetti, E, Dunn, TB, Ratner, LE, Kapur, S, Pelletier, RP, Roberts, JP, Melcher, ML, Singh, P, Sudan, DL, Posner, MP, El-Amm, JM, Shapiro, R, Cooper, M, Verbesey, JE, Lipkowitz, GS, Rees, MA, Marsh, CL, Sankari, BR, Gerber, DA, Wellen, JR, Bozorgzadeh, A, Gaber, AO, Heher, EC, Weng, FL, Djamali, A, Helderman, JH, Concepcion, BP, Brayman, KL, Oberholzer, J, Kozlowski, T, Covarrubias, K, Massie, AB, McAdams-DeMarco, MA, Segev, DL & Garonzik-Wang, JM 2023, 'Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients', American Journal of Transplantation, vol. 23, no. 12, pp. 1980-1989. https://doi.org/10.1016/j.ajt.2023.09.010

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title = "Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients",

abstract = "Older compatible living donor kidney transplant (CLDKT) recipients have higher mortality and death-censored graft failure (DCGF) compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant (ILDKT) recipients who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997, and December 15, 2016, we compared mortality, DCGF, delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age ≥60 years) and 1172 younger (age 18-59 years) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17 542 CLDKT recipients, we used an interaction term to determine whether the relationship between posttransplant outcomes and transplant type (ILDKT vs CLDKT) was modified by age. Overall, older recipients had higher mortality (hazard ratio: 1.632.072.65, P <.001), lower DCGF (hazard ratio: 0.360.530.77, P =.001), and AR (odds ratio: 0.390.540.74, P <.001), and similar DGF (odds ratio: 0.461.032.33, P =.9) and LOS (incidence rate ratio: 0.880.981.10, P = 0.8) compared to younger recipients. The impact of age on mortality (interaction P =.052), DCGF (interaction P =.7), AR interaction P =.2), DGF (interaction P =.9), and LOS (interaction P =.5) were similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.",

keywords = "HLA-incompatible, clinical research/practice, kidney transplantation, living donor, older, outcomes",

author = "Long, {Jane J.} and Motter, {Jennifer D.} and Jackson, {Kyle R.} and Jennifer Chen and Orandi, {Babak J.} and Montgomery, {Robert A.} and Stegall, {Mark D.} and Jordan, {Stanley C.} and Enrico Benedetti and Dunn, {Ty B.} and Ratner, {Lloyd E.} and Sandip Kapur and Pelletier, {Ronald P.} and Roberts, {John P.} and Melcher, {Marc L.} and Pooja Singh and Sudan, {Debra L.} and Posner, {Marc P.} and El-Amm, {Jose M.} and Ron Shapiro and Matthew Cooper and Verbesey, {Jennifer E.} and Lipkowitz, {George S.} and Rees, {Michael A.} and Marsh, {Christopher L.} and Sankari, {Bashir R.} and Gerber, {David A.} and Wellen, {Jason R.} and Adel Bozorgzadeh and Gaber, {A. Osama} and Heher, {Eliot C.} and Weng, {Francis L.} and Arjang Djamali and Helderman, {J. Harold} and Concepcion, {Beatrice P.} and Brayman, {Kenneth L.} and Jose Oberholzer and Tomasz Kozlowski and Karina Covarrubias and Massie, {Allan B.} and McAdams-DeMarco, {Mara A.} and Segev, {Dorry L.} and Garonzik-Wang, {Jacqueline M.}",

note = "Publisher Copyright: {\textcopyright} 2023 American Society of Transplantation & American Society of Transplant Surgeons",

year = "2023",

month = dec,

doi = "10.1016/j.ajt.2023.09.010",

language = "English (US)",

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T1 - Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients

AU - Long, Jane J.

AU - Motter, Jennifer D.

AU - Jackson, Kyle R.

AU - Chen, Jennifer

AU - Orandi, Babak J.

AU - Montgomery, Robert A.

AU - Stegall, Mark D.

AU - Jordan, Stanley C.

AU - Benedetti, Enrico

AU - Dunn, Ty B.

AU - Ratner, Lloyd E.

AU - Kapur, Sandip

AU - Pelletier, Ronald P.

AU - Roberts, John P.

AU - Melcher, Marc L.

AU - Singh, Pooja

AU - Sudan, Debra L.

AU - Posner, Marc P.

AU - El-Amm, Jose M.

AU - Shapiro, Ron

AU - Cooper, Matthew

AU - Verbesey, Jennifer E.

AU - Lipkowitz, George S.

AU - Rees, Michael A.

AU - Marsh, Christopher L.

AU - Sankari, Bashir R.

AU - Gerber, David A.

AU - Wellen, Jason R.

AU - Bozorgzadeh, Adel

AU - Gaber, A. Osama

AU - Heher, Eliot C.

AU - Weng, Francis L.

AU - Djamali, Arjang

AU - Helderman, J. Harold

AU - Concepcion, Beatrice P.

AU - Brayman, Kenneth L.

AU - Oberholzer, Jose

AU - Kozlowski, Tomasz

AU - Covarrubias, Karina

AU - Massie, Allan B.

AU - McAdams-DeMarco, Mara A.

AU - Segev, Dorry L.

AU - Garonzik-Wang, Jacqueline M.

PY - 2023/12

Y1 - 2023/12

N2 - Older compatible living donor kidney transplant (CLDKT) recipients have higher mortality and death-censored graft failure (DCGF) compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant (ILDKT) recipients who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997, and December 15, 2016, we compared mortality, DCGF, delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age ≥60 years) and 1172 younger (age 18-59 years) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17 542 CLDKT recipients, we used an interaction term to determine whether the relationship between posttransplant outcomes and transplant type (ILDKT vs CLDKT) was modified by age. Overall, older recipients had higher mortality (hazard ratio: 1.632.072.65, P <.001), lower DCGF (hazard ratio: 0.360.530.77, P =.001), and AR (odds ratio: 0.390.540.74, P <.001), and similar DGF (odds ratio: 0.461.032.33, P =.9) and LOS (incidence rate ratio: 0.880.981.10, P = 0.8) compared to younger recipients. The impact of age on mortality (interaction P =.052), DCGF (interaction P =.7), AR interaction P =.2), DGF (interaction P =.9), and LOS (interaction P =.5) were similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.

AB - Older compatible living donor kidney transplant (CLDKT) recipients have higher mortality and death-censored graft failure (DCGF) compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant (ILDKT) recipients who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997, and December 15, 2016, we compared mortality, DCGF, delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age ≥60 years) and 1172 younger (age 18-59 years) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17 542 CLDKT recipients, we used an interaction term to determine whether the relationship between posttransplant outcomes and transplant type (ILDKT vs CLDKT) was modified by age. Overall, older recipients had higher mortality (hazard ratio: 1.632.072.65, P <.001), lower DCGF (hazard ratio: 0.360.530.77, P =.001), and AR (odds ratio: 0.390.540.74, P <.001), and similar DGF (odds ratio: 0.461.032.33, P =.9) and LOS (incidence rate ratio: 0.880.981.10, P = 0.8) compared to younger recipients. The impact of age on mortality (interaction P =.052), DCGF (interaction P =.7), AR interaction P =.2), DGF (interaction P =.9), and LOS (interaction P =.5) were similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.

KW - HLA-incompatible

KW - clinical research/practice

KW - kidney transplantation

KW - living donor

KW - older

KW - outcomes

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M3 - Article

C2 - 37748554

AN - SCOPUS:85176133004

SN - 1600-6135

VL - 23

SP - 1980

EP - 1989

JO - American Journal of Transplantation

JF - American Journal of Transplantation

IS - 12

ER -

Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients

Abstract

Keywords

ASJC Scopus subject areas

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