AUTHOR=Fayos Marina , Corbella Laura , Rodriguez-Goncer Isabel , Trujillo Hernando , López-Medrano Francisco , González Esther , Hernández Ana , Ruiz-Merlo Tamara , San-Juan Rafael , Redondo Natalia , Andrés Amado , Aguado José María , Fernández-Ruiz Mario 

TITLE=Infection Risk in Older Kidney Transplant Recipients: An Analysis in the Era of Expanded Age Limits

JOURNAL=Transplant International

VOLUME=Volume 38 - 2025

YEAR=2025

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.15594

DOI=10.3389/ti.2025.15594

ISSN=1432-2277

ABSTRACT=The expansion of eligibility criteria has led to an increase in the age at kidney transplantation (KT), with consequences on the infection risk. We performed a prospective single-center cohort study of 712 patients undergoing KT between 2014 and 2022. Recipient age (median: 56.6 years [interquartile range: 43.2–68.5]) was analyzed by 10-year strata and dichotomized by thresholds (≥60, ≥70, ≥75 and ≥80). Univariable and multivariable regression models were constructed to assess the incidence of overall, bacterial and opportunistic post-transplant infection. In unadjusted analyses, each 10-year-increase was associated with overall (subdistribution hazard ratio [SHR]: 1.18; 95% confidence interval [CI]: 1.11–1.26), bacterial (SHR: 1.17; 95% CI: 1.09–1.26) and opportunistic infection (SHR: 1.26; 96% CI: 1.13–1.40). All groups >50 had an increased risk of infection. After multivariable adjustment, this association remained significant for overall (adjusted SHR [aSHR] per 10-year-increase: 1.09; 95% CI: 1.02–1.18) and bacterial infection (aSHR per 10-year-increase: 1.09; 95% CI: 1.00–1.18). Recipients ≥60 exhibited higher risk of overall infection (aSHR: 1.25; 95% CI: 1.00–1.54), and recipients ≥70 higher risk of opportunistic infection (aSHR: 1.54; 95% CI: 1.02–2.32). The incidence of infection was not significantly higher for patients ≥80 years. In conclusion, infection risk after KT increases with age, notably beyond 60 years.