Peripheral Artery Disease Linked to Higher Risk for Mortality Post-Kidney Transplant

METHODS

• Researchers conducted a retrospective study using registry and healthcare claims data to identify factors associated with mortality and hospitalisation in older kidney transplant recipients.
• They analysed 749 patients (67.4% men) aged 65 years or older who started kidney replacement therapy between 2017 and 2018 and underwent a first kidney transplant before December 2020.
• Patients were categorised into three age groups: 65-69 years (n = 291), 70-74 years (n = 236), and older than 75 years (n = 222); 191 patients received kidney transplant as the first kidney replacement therapy modality, and 104 patients received grafts from living donors.
• The 1-year all-cause mortality and key hospitalisation outcomes — including the initial length of hospital stay, 30-day readmission rates, and cumulative hospital days during the first posttransplant year — were assessed.
• Data on pretransplant cardiovascular-related hospitalisations, outpatient procedures, and specialist consultations performed in the 2 years before waitlist registration and up to the point of active waitlisting were extracted from the healthcare database and analysed.

Results

• The chronological age group did not reveal an independent relationship with mortality rates within 1 year after kidney transplantation as a whole, although recipients over the age of 75 tended to increase the risk of mortality.
• Peripheral artery disease at the beginning of renal replacement therapy was independently associated with an approximately two-fold increase in mortality risk during the first year after transplantation (adjusted risk coefficient was 1.97; P = 0.04). Chronic heart failure, at least two vascular surgery consultations before signing up for the waiting list, and hospitalization for vascular reasons (with the exception of vascular access for dialysis) were also independently associated with an increased risk of death.
• Age 70-74 years, chronic respiratory failure, and arrhythmia were independently associated with a longer initial hospital stay for the transplant procedure (> 21 days); age over 75 years and arrhythmia were associated with a longer total hospital stay exceeding 30 days during the first year after transplantation.
• Overall, 56% of patients were readmitted within a month of being discharged home; female gender and longer initial hospitalization were independent predictors of early readmission.

 

Implementing a structured geriatric assessment prior to transplantation could help to identify patients at higher risk, enable timely corrective interventions, and ultimately enhance both clinical outcomes and cost-effectiveness in this vulnerable population.

https://www.medscape.com/viewarticle/peripheral-artery-disease-linked-higher-risk-mortality-post-2026a10010bd