ORIGINAL RESEARCH
Transpl Int
Volume 38 - 2025 | doi: 10.3389/ti.2025.14544
This article is part of the Special IssueSilver Linings: Navigating the Challenges and Opportunities of Organ Transplantation in an Ageing PopulationView all articles
The impact of patient age on causes of graft loss after renal transplantation
Susanne Winkler1*
Min-Jeong Kim2Andrea Fisler3Stefan Farese4Felix Burkhalter5Seraina Von Moos6Christian Forster7
Caroline Wehmeier1Michael Dickenmann1
Stefan Schaub1*- 1Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
- 2Aarau Cantonal Hospital, Aarau, Switzerland
- 3Kantonsspital Baden, Baden, Switzerland
- 4Bürgerspital Solothurn, Solothurn, Switzerland
- 5Cantonal Hospital Baselland (KSBL), Liestal, Switzerland
- 6Luzerner Kantonsspital, Lucerne, Switzerland
- 7Department of Internal Medicine, Cantonal Hospital Olten (KSO), Olten, Switzerland
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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.
Keywords: Renal transplantation, allograft loss, recipient age, Death with graft function, allograft rejection
Received: 26 Feb 2025; Accepted: 18 Apr 2025.
Copyright: © 2025 Winkler, Kim, Fisler, Farese, Burkhalter, Von Moos, Forster, Wehmeier, Dickenmann and Schaub. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Susanne Winkler, Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
Stefan Schaub, Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
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