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Background <p>Kidney transplantation in recipients aged ≥ 70 years is increasing, yet outcome data remain heterogeneous, with current evidence being limited to pooled results from single and multicenter studies. This study aims to investigate the impact of advanced age on patient survival as well as graft-related outcomes from multicenter and registry-based studies and to propose a multicenter study to bridge any identified research gap.</p> Methods <p>The PRISMA and the Cochrane Handbook were followed. This review included multicenter studies and registry-based comparative studies only, which are less prone to selection bias. Outcomes were analysed using risk ratios (RRs) at fixed time points, when applicable, with a random-effects Mantel–Haenszel model.</p> Results <p>Five multicenter studies including a total of 272,982 recipients, of whom 16,309 were aged ≥ 70 years, were included. Recipients aged ≥ 70 years had a lower overall and 5-year survival, RR = 0.87 (95% CI 0.77–0.99; p = 0.04, I<sup>2</sup> = 96%, τ<sup>2</sup> = 0.00) and RR = 0.86 (95% CI 0.81–0.92; <i>p</i> = 0.02, <i>I</i><sup>2</sup> = 0%, <i>τ</i><sup>2</sup> = 0.00), respectively, compared to &lt; 70. No significant differences were observed for 1- and 3-year patient survival between the two age groups. Moreover, no significant differences were observed for overall graft survival, 1-, 3-, or 5-year graft survival, delayed graft function, acute rejection and graft loss between the two age groups. Substantial heterogeneity was observed for long-term outcomes.</p> Conclusion <p>Kidney transplantation in carefully selected recipients aged ≥ 70 years is associated with preserved graft survival and comparable early graft-related outcomes, but lower overall and 5-year survival, compared to those &lt; 70 years of age. However, due to the limited number of studies included and substantial heterogeneity, future large multicenter studies including geriatric variables are required to determine the role of age on patient survival and graft-related outcomes.</p> Trial registration <p>PROSPERO: CRD420261293247.</p>

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Kidney transplant outcomes in patients aged ≥ 70 years: a systematic review and meta-analysis of multicenter or registry-based studies with future directions and a multicenter study proposal

  • 期刊论文

  • 发表日期：

    2026年4月19日

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  • Dionysios Prevezanos,
  • Konstantinos Kossenas,
  • Spyridon Vernadakis,
  • Stylianos Kykalos,
  • Nikolaos Nikiteas,
  • Dimitrios Dimitroulis

摘要

Background

Kidney transplantation in recipients aged ≥ 70 years is increasing, yet outcome data remain heterogeneous, with current evidence being limited to pooled results from single and multicenter studies. This study aims to investigate the impact of advanced age on patient survival as well as graft-related outcomes from multicenter and registry-based studies and to propose a multicenter study to bridge any identified research gap.

Methods

The PRISMA and the Cochrane Handbook were followed. This review included multicenter studies and registry-based comparative studies only, which are less prone to selection bias. Outcomes were analysed using risk ratios (RRs) at fixed time points, when applicable, with a random-effects Mantel–Haenszel model.

Results

Five multicenter studies including a total of 272,982 recipients, of whom 16,309 were aged ≥ 70 years, were included. Recipients aged ≥ 70 years had a lower overall and 5-year survival, RR = 0.87 (95% CI 0.77–0.99; p = 0.04, I2 = 96%, τ2 = 0.00) and RR = 0.86 (95% CI 0.81–0.92; p = 0.02, I2 = 0%, τ2 = 0.00), respectively, compared to < 70. No significant differences were observed for 1- and 3-year patient survival between the two age groups. Moreover, no significant differences were observed for overall graft survival, 1-, 3-, or 5-year graft survival, delayed graft function, acute rejection and graft loss between the two age groups. Substantial heterogeneity was observed for long-term outcomes.

Conclusion

Kidney transplantation in carefully selected recipients aged ≥ 70 years is associated with preserved graft survival and comparable early graft-related outcomes, but lower overall and 5-year survival, compared to those < 70 years of age. However, due to the limited number of studies included and substantial heterogeneity, future large multicenter studies including geriatric variables are required to determine the role of age on patient survival and graft-related outcomes.

Trial registration

PROSPERO: CRD420261293247.