{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:30:01Z","timestamp":1793651401297,"version":"4.5.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background.<\/jats:title>\n Older adults represent a growing proportion of kidney transplant (KT) recipients, but early posttransplant morbidity remains substantial. We aimed to identify pretransplant factors associated with a complicated early posttransplant course in recipients aged \u226565 y and to assess its impact on subsequent outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods.<\/jats:title>\n We conducted a single-center retrospective cohort study of KT recipients aged \u226565 y. The primary in-hospital composite outcome comprised length of stay >15 d, infectious complications, delayed graft function, primary nonfunction, or in-hospital death. Patients were classified as complicated or noncomplicated. Univariable and multivariable logistic regression identified predictors of the composite outcome. Postdischarge outcomes included death, all-cause hospitalization, clinically relevant infections, surgical\/urological complications, and kidney function at last follow-up. Clinical events were assessed by survival analyses and kidney function by adjusted models.<\/jats:p>\n <\/jats:sec>\n \n Results.<\/jats:title>\n Ninety-three recipients were included (median age 68.5 y; 40% aged >70 y); 61 experienced a complicated in-hospital course. In multivariable analysis, longer dialysis vintage and donor hypertension were associated with higher odds of the composite outcome, whereas preemptive transplantation and living donation were associated with lower odds. During a median follow-up of 29.8 mo, patients with a complicated early course had numerically higher rates of the composite clinical endpoint, hospitalization, and infection, but these differences were not statistically significant in Cox regression analyses. Crude estimated glomerular filtration rate was lower among patients with a complicated course; however, kidney function was comparable after adjustment for discharge estimated glomerular filtration rate.<\/jats:p>\n <\/jats:sec>\n \n Conclusions.<\/jats:title>\n Among KT recipients aged \u226565 y, longer dialysis exposure and donor hypertension were key determinants of a complicated early posttransplant course, while preemptive and living-donor transplantation appeared protective. Early complications were associated with numerically higher postdischarge event rates but were not independently associated with worse subsequent outcomes. These findings support minimizing dialysis exposure, careful donor selection, and close perioperative management in older KT recipients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/txd.0000000000002004","type":"journal-article","created":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:00:25Z","timestamp":1793649625000},"page":"e2004","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Early Posttransplant Complications and Clinical Outcomes in Kidney Transplant Recipients Aged \u226565 y"],"prefix":"10.1097","volume":"12","author":[{"given":"Daniele","family":"Vetrano","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Gessaroli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Corradetti","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Muccini","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinela","family":"Skijau","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vania","family":"Cuna","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Grandinetti","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Abenavoli","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelodaniele","family":"Napoletano","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Bini","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Zanfi","sequence":"additional","affiliation":[{"name":"General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Odaldi","sequence":"additional","affiliation":[{"name":"General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Ravaioli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."},{"name":"General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5473-8551","authenticated-orcid":false,"given":"Gaetano","family":"La Manna","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Comai","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy."},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"R1-20261102","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: an update 2022.","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int Suppl (2011)"},{"key":"R2-20261102","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1016\/S0140-6736(25)01853-7","article-title":"Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023.","volume":"406","year":"2025","journal-title":"Lancet"},{"key":"R3-20261102","doi-asserted-by":"crossref","first-page":"9538115","DOI":"10.1155\/ijne\/9538115","article-title":"Dialysis in the elderly: a practical guide for the 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Med"},{"key":"R10-20261102","doi-asserted-by":"crossref","first-page":"23018","DOI":"10.1038\/s41598-024-73735-8","article-title":"A systematic review and quality assessment of economic evaluations of kidney replacement therapies in end-stage kidney disease.","volume":"14","author":"Nyokabi","year":"2024","journal-title":"Sci Rep"},{"key":"R11-20261102","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1097\/TP.0000000000000474","article-title":"A paired survival analysis comparing hemodialysis and kidney transplantation from deceased elderly donors older than 65 years.","volume":"99","author":"Lloveras","year":"2015","journal-title":"Transplantation"},{"key":"R12-20261102","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/j.ajt.2023.07.006","article-title":"Survival after kidney transplantation compared with ongoing dialysis for people over 70 years of age: a matched-pair analysis.","volume":"23","author":"Shi","year":"2023","journal-title":"Am J 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A propensity score matched analysis of a large European registry cohort.","volume":"37","author":"Toapanta","year":"2024","journal-title":"Transpl Int"},{"key":"R23-20261102","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.eclinm.2018.09.007","article-title":"Equivalent long-term transplantation outcomes for kidneys donated after brain death and cardiac death: conclusions from a nationwide evaluation.","volume":"4-5","author":"Schaapherder","year":"2018","journal-title":"EClinicalMedicine"},{"key":"R24-20261102","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1053\/ajkd.2000.8288","article-title":"Impact of pre-existing donor hypertension and diabetes mellitus on cadaveric renal transplant outcomes.","volume":"36","author":"Ojo","year":"2000","journal-title":"Am J Kidney Dis"},{"key":"R25-20261102","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1111\/tri.13947","article-title":"Long-term kidney function and survival in recipients of allografts from living kidney donors with hypertension: a national cohort study.","volume":"34","author":"Al Ammary","year":"2021","journal-title":"Transpl Int"},{"key":"R26-20261102","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1097\/HJH.0000000000003246","article-title":"Impact of donor hypertension on graft survival and function in living and deceased donor kidney transplantation: a nationwide prospective cohort study.","volume":"40","author":"Lee","year":"2022","journal-title":"J Hypertens"},{"key":"R27-20261102","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.12659\/MSM.909706","article-title":"Receiving hypertensive donor grafts is associated with inferior prognosis in simultaneous liver-kidney transplantation recipients.","volume":"24","author":"Zhu","year":"2018","journal-title":"Med Sci Monit"},{"key":"R28-20261102","first-page":"49","article-title":"Effect of donor hypertension on renal transplant recipients\u2019 blood pressure, allograft outcomes and survival: 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