Estimating the Benefit of Transplant Over Dialysis in Candidates Over 55 Years

Key Points Older kidney transplant candidates experience a gain in life years from transplantation. More updated models using a contemporary cohort are needed to guide current clinical practice for older adults. The magnitude of gain in life years from transplant has diminished in recent years, likely driven by candidate characteristics and policy changes. Background Life Years from Transplant (LYFT) is a measure of the predicted difference between the expected lifespan with and without a kidney transplant. The metric was originally proposed in 1999; since then, demographics of the kidney transplant candidate population have materially changed. Methods Using contemporary Scientific Registry of Transplant Recipients data, we propose more sophisticated methods for estimating LYFT with a focus on older kidney transplant candidates, a growing sector of the current candidate pool. We examine trends in predicted LYFT from 1995 to 2020. Results We show that among older patients on the deceased donor waitlist, transplant remains a better option compared with dialysis (overall LYFT=5 years). LYFT trends have diminished modestly (by <1 life year) over time, in part related to efforts to enhance access to transplantation through intercurrent policy changes. Conclusions Updated LYFT estimates remain informative clinical measures that can support patient-centered decision-making. However, less homogenous metrics with meaningful disaggregation are needed to inform institutional evaluation and policy change. Models should be repeatedly evaluated as demographics of the candidate pool evolve.