Relationship of recipient age and development of chronic allograft failure

Background. The elderly are the fastest growing segment of the end stage re nal disease (ERSD) population, Older renal transplant recipients experience fewer acute rejection episodes than do younger patients, Despite this, dea th censored graft survival is no better in these older transplant recipient s than in younger recipients. We examined the United States Renal Data Syst em (USRDS) database to determine whether recipient age itself has an indepe ndent effect on the development of chronic allograft failure (CAF). Methods. Ne analyzed 59,509 patients from the files of the USRDS. To determ ine whether age was an independent risk factor for CAF, the population was analyzed separately for Caucasians, African-Americans, and other ethnic gro ups. All renal transplant recipients from 1988 to 1997 were examined. Both univariate and multivariate analysis were performed using chronic allograft failure as the outcome of interest. Results. Actuarial 8-year censored graft survival was significantly decreas ed in the older age groups 67% for ages 18-49 vs. 61.8% for ages 50-64 vs. 50.7% for ages 65+ (P<0.001). In the multivariate analysis, recipient age w as a strong and independent risk factor for the development of chronic allo graft failure in Caucasians (RR 1.29 for ages 50-64, RR 1.67 for ages older than 65). These findings mere reinforced by an analysis that was restricte d to living donor transplants without acute rejection. Conclusion, In Caucasians increased recipient age is an independent risk fa ctor for the development of chronic renal allograft failure.