title: Recipient age and risk for mortality after kidney transplantation in England.
abstract: BACKGROUND
  The aim of this study was to explore age-related mortality post-kidney transplantation in England over the last decade.
  
  
  METHODS
  This study used data from Hospital Episode Statistics to select all kidney transplant procedures performed in England between April 2001 and March 2012. Demographics and medical comorbidities (based upon ICD-10 codes) were extracted at baseline. Data linkage analysis was performed with the Office for National Statistics to identify all deaths occurring among this study cohort.
  
  
  RESULTS
  Data for 19,103 kidney transplant procedures was analyzed, with a median follow-up of 4.4 years (interquartile range 2.2-7.3 years). Categorization of age cohorts at time of transplantation were age below 50 (n=11,421, 59.8%), 50 to 59 (n=4,195, 22.0%), 60 to 69 (n=2,887, 15.1%), 70 to 79 (n=589, 3.1%), and 80 and above (n=11, 0.1%). There were 2,085 deaths that occurred among the study cohort during follow-up and mortality risk increased with age: below 50 (5.8%), 50 to 59 (14.2%), 60 to 69 (22.0%), 70 to 79 (31.9%), and 80 and above (45.5%). The three most common causes of deaths for recipients 70 and over were cardiac (21.2%), infection (21.2%), and malignancy (20.2%), respectively. Lower mortality was observed with the receipt of a living-donor kidney for recipients aged 70 and above. On Cox regression analysis, risk for death increased with each additional decade of recipient age over 50.
  
  
  CONCLUSIONS
  Increasing age is a strong, independent risk factor for death after kidney transplantation. Although lower mortality was observed with living kidney transplantation among elderly recipients, living-donor rates decrease with increasing recipient age. Pretransplant counseling and posttransplant tailored immunosuppression should be explored, the latter requiring targeted clinical trials.
authors.affiliation: 1 Department of Nephrology and Transplantation, Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK. 2 Medical School, University of Birmingham, Birmingham, UK. 3 Department of Medical Informatics, Queen Elizabeth Hospital, Birmingham, UK. 4 Address correspondence to: Adnan Sharif, M.D., Renal Institute of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2WB, UK.
authors.forename: Asra
authors.initials: A
authors.lastname: Karim
authors.forename: Daniela
authors.initials: D
authors.lastname: Farrugia
authors.forename: James
authors.initials: J
authors.lastname: Cheshire
authors.forename: Sophia
authors.initials: S
authors.lastname: Mahboob
authors.forename: Irena
authors.initials: I
authors.lastname: Begaj
authors.forename: Daniel
authors.initials: D
authors.lastname: Ray
authors.forename: Adnan
authors.initials: A
authors.lastname: Sharif
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003644:Death Certificates; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D007239:Infections / Q000401:mortality*; D038801:International Classification of Diseases; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors