title: Should patients older than 65 years be offered a second kidney transplant?
abstract: BACKGROUND
  Age and number of recipients in need of kidney re-transplantation are increasing. Re-transplantation practices and outcomes in elderly recipients are not previously explored. We aimed to retrospectively evaluate the outcomes of recipients 65 years and older receiving their second deceased donor allograft.
  
  
  METHODS
  The study was designed as a retrospective registry based study. All recipients 65 years or older who received a deceased donor kidney transplant at Oslo University Hospital between 2000 and 2014 were included in the study. Survival outcomes were compared between recipients of first (TX1) and second (TX2) allograft. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazard models with patient survival, uncensored graft survival and death-censored graft survival as outcomes in the analyses.
  
  
  RESULTS
  Seven hundred and thirty-tree recipients > 65 years received a first (n = 687) or second (n = 46) deceased donor kidney transplant. Five years uncensored graft survival rates were 64% in TX 2 and 67% in TX 1 (P=﻿ 0.789). Estimated five years graft survival rates censored for death with functioning graft were 88% in TX2 and 90% in TX1 (P=0.475). Adjusted hazard ratio for uncensored graft loss (TX2 vs. TX1) was 1.24 (95% CI 0.77 - 2.00). Adjusted hazard ratio for graft loss censored for death with functioning graft (TX2 vs. TX1) was 1.70 (0.72-4.02).
  
  
  CONCLUSIONS
  Older recipients of second transplants have outcomes that are comparable to the outcomes of age-matched first transplant recipients, and far better than previously documented for older transplant candidates remaining on dialysis treatment. Advanced age by itself should not be a contraindication for re-transplantation. Best results are achieved with short time on dialysis before re-transplantation.
authors.affiliation: Department of Cardiology, Nephrology, Endocrinology and Geriatrics, Clinic of Internal Medicine, Telemark Hospital Trust, N-3710, Skien, Norway. kristian.heldal@sthf.no.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. kristian.heldal@sthf.no.
authors.forename: Kristian
authors.identifier: http://orcid.org/0000-0003-4427-9528
authors.initials: K
authors.lastname: Heldal
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Lønning
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisæter
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Pål-Dag
authors.initials: PD
authors.lastname: Line
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Karsten
authors.initials: K
authors.lastname: Midtvedt
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004608:Eligibility Determination / Q000706:statistics & numerical data; D006084:Graft Rejection / Q000401:mortality* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D009664:Norway / Q000453:epidemiology; D018579:Patient Selection; D012042:Registries; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: Chronic renal failure; Elderly; Epidemiology; Graft survival; Kidney transplantation