Clin Transplant. 2026 May;40(5):e70546. doi: 10.1111/ctr.70546.
ABSTRACT
INTRODUCTION: Kidney transplantation (KT) improves survival and quality of life for older adults with kidney failure, yet older adults may be referred less often. We aimed to compare KT referral, waitlist activation, and transplantation rates by age in a contemporary Canadian cohort.
METHODS: We examined adult patients with kidney failure (initiating maintenance dialysis or referred for preemptive KT) in Nova Scotia from 2010 to 2020. Transplant-eligible patients aged 18-80 years were categorized by age (≤60, >60-70, and >70-80 years). Multivariable Fine and Gray subdistribution hazard and logistic regression models assessed time to transplant referral, odds of waitlist activation, and time to transplantation, adjusting for demographics, comorbidities, and frailty.
RESULTS: Of 1153 patients, 785 were potentially eligible for KT. Adjusted subdistribution hazard ratios (aSHR) for transplant referral were significantly lower for older groups (aSHR 0.73, 95% confidence interval [CI]: 0.57-0.93 for >60-70 years and aSHR 0.24, 95% CI: 0.17-0.34 for >70-80 years). There were no significant differences in odds of waitlisting if referred (odds ratio 0.76, 95% CI: 0.45-1.29 for >60-70 years and 0.74, 95% CI: 0.30-1.86 for >70-80 years) or in time to transplantation if waitlisted (aSHR 0.79, 95% CI: 0.55-1.13 for >60-70 years and aSHR 0.55, 95% CI: 0.28-1.08 for >70-80 years).
CONCLUSION: Older adults in Nova Scotia, Canada, experience significantly lower kidney transplant referral rates, with no differences in waitlist activation or time to transplant. Interventions to improve access to transplant for older individuals should focus on improving KT referral.
PMID:42053900 | DOI:10.1111/ctr.70546
