Association Between Age at Kidney Transplantation and Risk of Early Graft Loss

BACKGROUND: Adolescence has been identified as a high-risk period for graft failure. However, existing knowledge on this topic is largely limited to long-term graft outcomes. The aim of this study was to examine the association between age at kidney transplantation and early graft loss, defined as graft failure within 3 years post-transplantation in the contemporary era. METHODS: This study was a retrospective analysis of 55 973 first-time kidney transplant recipients identified in the U.S. Renal Data System from January 1, 2005, to December 31, 2021. Adjusted Cox proportional hazards regression models were used to evaluate the association between age at transplantation and early graft failure including an interaction term for race/ethnicity. RESULTS: Adolescents (12 to < 18 years) and young adults (18 to < 26 years) were at the highest risk of early death-censored graft loss compared to young adults (26 to < 40 years), with hazard ratios of 1.95 (95% CI 1.74-2.17) and 2.01 (95% CI 1.86-2.17), respectively. Additionally, we found that the effect of age on early graft loss varied significantly by race, with disparities observed among Asian and Black youth. CONCLUSION: These findings highlight a persistently elevated risk in adolescents and young adults in the contemporary era.