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An alternative approach to estimate age-related mortality of kidney transplant recipients compared to the general population: results in favor of old-to-old transplantations

Yohann Foucher 1, 2, 3, * Ahmed Akl 1, 3, 4 Vanessa Rousseau 5 Katy Trébern-Launay 1, 3 Marine Lorent 1, 3 Michèle Kessler 6 Marc Ladrière 6 Christophe Legendre 7, 8 Henri Kreis 7, 8 Lionel Rostaing 9 Nassim Kamar 9 Georges Mourad 10 Valèrie Garrigue 11 Emmanuel Morelon 12 Fanny Buron 12 Jean-Pierre Daurès 5 Jean-Paul Soulillou 1, 3 Magali Giral 1, 3, 13
* Corresponding author
1 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
2 Biostatistique, Recherche Clinique et Mesures Subjectives en Santé
3 ITUN - Institut de transplantation urologie-néphrologie
4 Urology and Nephrology Center [Mansoura, Egypt]
5 Unité de Biostatistiques et Épidémiologie [Montpellier]
6 Service de transplantation rénale [CHRU Nancy]
7 UPD5 - Université Paris Descartes - Paris 5
8 CHU Necker - Enfants Malades [AP-HP]
9 Département de Néphrologie, dialyse et transplantation [Hôpital de Rangueil, Toulouse]
10 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415
11 Hôpital Lapeyronie [Montpellier] CHU - Service de Néphrologie, Dialyse et Transplantation
12 Department of Nephrology, Transplantation and Clinic Immunology [Hospices civils de Lyon]
13 CIC biothérapies CBT 0503 [Nantes]
Abstract : Compared to dialysis, kidney transplantation appears to be the best treatment for chronic kidney failure, even for older aged patients. Nevertheless, the individual benefit of transplanting elderly patients has to be balanced against the corresponding increase in the number of patients awaiting grafts. We analyzed the excess mortality related to kidney transplant recipients by taking into account the expected mortality of the general population (additive regression model for relative survival). We applied this method to a cohort of patients who received a first deceased-donor kidney transplant between 1998 and 2009 in France (DIVAT, n = 3641). Overall 10-year mortality was 13%. As expected, recipient age was the main risk factor associated with overall mortality. In contrast, recipient age was no longer significantly associated with the excess of mortality related to kidney transplant status by subtracting the expected mortality of the general population. Delayed graft function (DGF), pretransplantation immunization, and past history of diabetes appeared as the main risk factors of this higher mortality rate. Our results constitute a strong argument in favor of kidney transplantation, regardless of the patient's age. Preventing DGF may be more effective for decreasing the risk of death specifically attributable to the disease.
Keywords : aging clinical epidemiology kidney transplantation mortality relative survival
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Submitted on : Monday, June 24, 2019 - 12:12:31 PM
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INSERM | HCL | HEH | UNIV-PARIS5 | UNIV-MONTPELLIER | UNIV-NANTES | CRTI | USPC | MIPS | UNIV-PARIS

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Yohann Foucher, Ahmed Akl, Vanessa Rousseau, Katy Trébern-Launay, Marine Lorent, et al.. An alternative approach to estimate age-related mortality of kidney transplant recipients compared to the general population: results in favor of old-to-old transplantations. Transplant International, Wiley, 2014, 27 (2), pp.219-225. ⟨10.1111/tri.12241⟩. ⟨inserm-02163439⟩

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