The Impact of Patient Age on Causes of Graft Loss After Renal Transplantation

The interplay of recipient age and graft loss causes is underexplored, despite its relevance for patient management and endpoint definition in clinical trials. This study aimed to investigate the impact of recipient age on graft loss causes. In this retrospective single-center cohort study with 1743 kidney transplantations between 1995 and 2022, graft losses were assigned to either death with graft function (DwGF) or graft failure (GF). Additionally, causes of death and GF were determined by reviewing all available clinical/histological information. Data were analyzed across recipient age groups (≤40, 41-60 and >60 years) and across three time periods (1995-2004, 2005-2014, 2015-2022). Among 816 graft losses, 56% were attributed to DwGF and 44% to GF. The proportion of DwGF increased stepwise with age (21% in young vs. 52% in middle-aged vs. 76% in elderly patients; p < 0.0001), with similar proportions across the three time periods. Rejection alone or in combination with other events caused GF in 76% of young, 51% of middle-aged, and 34% of elderly patients (p < 0.0001). Main death-causes were cardiovascular events (23%), infections (23%) and malignancies (23%). Graft loss causes are strongly age-related. This might have significant implications for clinical study design and patient management.