Immunosuppressant prescribing patterns in elderly kidney transplant recipients using registry data from Australia and New Zealand

Background The elderly is the fastest growing kidney transplant recipient group; however, they are more likely to die from immunosuppressant side effects than graft failure. Aim The aim of this study was to explore immunosuppressant prescribing practices in elderly kidney transplant recipients. Method We conducted a retrospective audit of registry data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry between 2000 and 2015, to determine the actual prescribing trends of immunosuppressant drugs in elderly recipients (>= 65 years). Drug choice and doses, prescribed initially and at 1 year, were examined, with a survival analysis conducted to determine if drug regimen influenced graft survival. Results Six hundred and one elderly recipients were included in the analysis. Elderly patients were less likely to be prescribed tacrolimus at 1 year than younger patients, and median doses (149.3 vs 155.6 micrograms/kg; p < 0.05) were significantly lower in elderly patients across the timeframe (initially and at 1-year post-transplant). We also observed that elderly recipients prescribed dual immunosuppressant therapy (compared to triple therapy) had an increased risk of graft loss (p < 0.05). Conclusion By examining Registry data across a 15-year span, we observed differences in both immunosuppressant usage and drug dosing trends in elderly recipients. The implications of these findings may suggest that guidelines need adjustment to reflect this.