Kevin A Nguyen1, Jamil S Syed1, Randy Luciano2, Brian Shuch1,3, Srinivas Vourganti4. 1. Department of Urology, Yale School of Medicine, New Haven, CT, USA. 2. Department of Medicine, Division of Nephrology, Yale School of Medicine, New Haven, CT, USA. 3. Department of Radiology, Yale School of Medicine, New Haven, CT, USA. 4. Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Abstract
BACKGROUND: For potential transplant recipients with a prior history of renal malignancy, no evidence-based recommendations currently exist with regard to waiting duration on dialysis. We aim to improve decision making by evaluating the impact of waiting duration on the outcomes of kidney cancer patients awaiting renal transplantation. METHODS: The United States Renal Data System was used to identify patients with a known cause of end-stage renal disease (ESRD) from 1983 to 2007. Evaluation of overall survival (OS) was performed with Kaplan-Meier estimates and Cox proportional hazards models. Fine-Gray competing risk models were used to assess cancer-specific mortality (CSM) and non-cancer-specific mortality (NCSM). RESULTS: Of 1 374 175 patients with ESRD, 228 984 (16.7%) received transplantation. Transplant recipients with renal malignancy-associated ESRD (RM-ESRD) had longer waiting durations than those with other known causes of ESRD (2.4 versus 1.3 years; P < 0.0001). RM-ESRD patients who had shorter waiting durations (0-2 years) had better OS than those who waited longer (2+ years) (10-year OS 69.0 versus 46.7%, respectively; P < 0.0001), with similar CSM (10-year CSM 10.3 versus 10.2%, respectively; P = 0.883), whereas NCSM was worse for those with longer waiting durations (10-year NCSM 20.7 versus 44.3%, respectively; P < 0.0001). On Cox modeling, the status of RM-ESRD was not a significant predictor (P = 0.07), while longer waiting duration remained significant (P < 0.0001). CONCLUSION: We found that CSM was not affected by waiting duration, while NCSM significantly improved with shorter wait times. These findings suggest that the OS of potential transplant recipients with RM-ESRD may be improved by reducing waiting duration.
BACKGROUND: For potential transplant recipients with a prior history of renal malignancy, no evidence-based recommendations currently exist with regard to waiting duration on dialysis. We aim to improve decision making by evaluating the impact of waiting duration on the outcomes of kidney cancer patients awaiting renal transplantation. METHODS: The United States Renal Data System was used to identify patients with a known cause of end-stage renal disease (ESRD) from 1983 to 2007. Evaluation of overall survival (OS) was performed with Kaplan-Meier estimates and Cox proportional hazards models. Fine-Gray competing risk models were used to assess cancer-specific mortality (CSM) and non-cancer-specific mortality (NCSM). RESULTS: Of 1 374 175 patients with ESRD, 228 984 (16.7%) received transplantation. Transplant recipients with renal malignancy-associated ESRD (RM-ESRD) had longer waiting durations than those with other known causes of ESRD (2.4 versus 1.3 years; P < 0.0001). RM-ESRD patients who had shorter waiting durations (0-2 years) had better OS than those who waited longer (2+ years) (10-year OS 69.0 versus 46.7%, respectively; P < 0.0001), with similar CSM (10-year CSM 10.3 versus 10.2%, respectively; P = 0.883), whereas NCSM was worse for those with longer waiting durations (10-year NCSM 20.7 versus 44.3%, respectively; P < 0.0001). On Cox modeling, the status of RM-ESRD was not a significant predictor (P = 0.07), while longer waiting duration remained significant (P < 0.0001). CONCLUSION: We found that CSM was not affected by waiting duration, while NCSM significantly improved with shorter wait times. These findings suggest that the OS of potential transplant recipients with RM-ESRD may be improved by reducing waiting duration.
Authors: H Meier-Kriesche; F K Port; A O Ojo; A B Leichtman; S M Rudich; J A Arndorfer; J D Punch; B Kaplan Journal: Transplant Proc Date: 2001 Feb-Mar Impact factor: 1.066
Authors: Bertram L Kasiske; Charles B Cangro; Sundaram Hariharan; Dondald E Hricik; Ronald H Kerman; David Roth; David N Rush; Miguel A Vazquez; Matthew R Weir Journal: Am J Transplant Date: 2001 Impact factor: 8.086
Authors: Scott Campbell; Helen Pilmore; David Gracey; William Mulley; Christine Russell; Steven McTaggart Journal: Nephrology (Carlton) Date: 2013-06 Impact factor: 2.506
Authors: H U Meier-Kriesche; F K Port; A O Ojo; S M Rudich; J A Hanson; D M Cibrik; A B Leichtman; B Kaplan Journal: Kidney Int Date: 2000-09 Impact factor: 10.612
Authors: Keun Hoi Park; Jung A Yoon; Hak Soo Kim; Hyosang Kim; Su-Kil Park; Young Hoon Kim; Bumsik Hong; Dalsan You; In Gab Jeong; Chung Hee Baek Journal: Kidney Res Clin Pract Date: 2019-12-31