Exponentially increased risk of infectious death in older renal transplantrecipients

Background. The benefit of renal transplantation for patients with end-stag e renal disease (ESRD) has been well documented. This benefit is seen throu ghout all age ranges of patients. However, it has been documented that olde r renal transplant recipients are at increased risk for death because of in fectious causes when compared with younger recipients. The present study ad dresses whether this increased risk merely parallels an age-related increas e in infectious mortality or is reflective of a particular vulnerability in older renal transplant recipients. Methods. Patients wait-listed and transplanted between 1988 and 1997 were a nalyzed utilizing the United States Renal Data System (USRDS) database. The primary study end point was patient death secondary to infection. Secondar y end points included death secondary to cardiovascular cause and malignanc y. Cox-proportional hazard models were utilized with all pertinent variable s. Results. Death related to infectious cause increased exponentially in trans planted patients with increasing age (slope = 2.9(0.34x)), while it increas ed linearly (slope = 1.9x + 8.6) with increasing age for those patients on the waiting list. Overall mortality increases with age were equal between t he wait-listed and transplanted groups. Conclusions. The overall survival benefit of transplantation is maintained in the older age groups. However, renal transplantation is associated with an increased risk for infectious death beyond the expected age-related incr eased risk in patients on the renal transplant waiting list. This may have an impact on future immunosuppressive regimens in this population.