SRS238 - Outcomes of kidney transplantation in recipients deemed high risk: a single centre experience

Abstract Background Kidney transplantation (KT) is increasingly offered to older, comorbid patients, deemed ‘high-risk recipients’ (HRR). We aimed to quantify outcomes and predictors of mortality in HRRs in a contemporary cohort. Methods We analysed 1125 consecutive adult KT recipients (2014–2023), including 161 (14.3%) designated HRR by multidisciplinary team (MDT). Baseline donor and recipient characteristics, perioperative outcomes, and 5-year survival were compared. Predictors of mortality were assessed using multivariable Cox regression, and HRR designation was predicted via logistic regression. Red cell distribution width (RDW), a validated frailty marker, was explored as a predictor of survival. Results HRRs were older (64 versus 53 years), more frequently diabetic, and had higher rates of ischaemic heart disease (IHD). Clavien–Dindo Complications Grade ≥III occurred more frequently in HRRs (24.2% versus 16.1%, P = 0.018). Patient 5-year survival was 85.7% for standard-risk versus 67.9% for HRRs (log-rank P < 0.0001). In adjusted multivariable Cox regression, age (HR 1.86 per decade, 95%c.i. 1.52–2.28), IHD (HR 2.53, 95%c.i. 1.47–4.33), retransplantation (HR 2.10, 95%c.i. 1.17–3.77), and RDW (HR 1.23 per 1% increase, 95%c.i. 1.09–1.39) independently predicted mortality (P < 0.001). Logistic regression indicated that age, diabetes, IHD, and prolonged waiting list duration predicted MDT high-risk designation (AUC 0.83). When HRR status alone was used in the model, it predicted worse 5-year survival (HR 1.86, 95%c.i. 1.16–2.96, P = 0.01). Conclusions HRRs experience lower 5-year survival. Recipient age and elevated RDW are dominant predictors of mortality, supporting integration of objective metrics with the already robust MDT assessment to improve prognostication and patient counselling.