Diana A Wu1, Matthew L Robb2, John L R Forsythe1,2, Clare Bradley3, John Cairns4, Heather Draper5, Christopher Dudley6, Rachel J Johnson2, Wendy Metcalfe1, Rommel Ravanan6, Paul Roderick7, Charles R V Tomson8, Christopher J E Watson9, J Andrew Bradley9, Gabriel C Oniscu1. 1. Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 2. NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom. 3. Health Psychology Research Unit, Orchard Building, Royal Holloway, University of London, Egham, Surrey, United Kingdom. 4. London School of Hygiene and Tropical Medicine, London, United Kingdom. 5. Health Sciences, University of Warwick, Coventry, United Kingdom. 6. Department of Renal Medicine, Southmead Hospital, Bristol, United Kingdom. 7. Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 8. Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom. 9. Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom.
Abstract
BACKGROUND: Comorbidity is increasingly common in kidney transplant recipients, yet the implications for transplant outcomes are not fully understood. We analyzed the relationship between recipient comorbidity and survival outcomes in a UK-wide prospective cohort study-Access to Transplantation and Transplant Outcome Measures (ATTOM). METHODS: A total of 2100 adult kidney transplant recipients were recruited from all 23 UK transplant centers between 2011 and 2013. Data on 15 comorbidities were collected at the time of transplantation. Multivariable Cox regression models were used to analyze the relationship between comorbidity and 2-year graft survival, patient survival, and transplant survival (earliest of graft failure or patient death) for deceased-donor kidney transplant (DDKT) recipients (n = 1288) and living-donor kidney transplant (LDKT) recipients (n = 812). RESULTS: For DDKT recipients, peripheral vascular disease (hazard ratio [HR] 3.04, 95% confidence interval [CI]: 1.37-6.74; P = 0.006) and obesity (HR 2.27, 95% CI: 1.27-4.06; P = 0.006) were independent risk factors for graft loss, while heart failure (HR 3.77, 95% CI: 1.79-7.95; P = 0.0005), cerebrovascular disease (HR 3.45, 95% CI: 1.72-6.92; P = 0.0005), and chronic liver disease (HR 4.36, 95% CI: 1.29-14.71; P = 0.018) were associated with an increased risk of mortality. For LDKT recipients, heart failure (HR 3.83, 95% CI: 1.15-12.81; P = 0.029) and diabetes (HR 2.23, 95% CI: 1.03-4.81; P = 0.042) were associated with poorer transplant survival. CONCLUSIONS: The key comorbidities that predict poorer 2-year survival outcomes after kidney transplantation have been identified in this large prospective cohort study. The findings will facilitate assessment of individual patient risks and evidence-based decision making.
BACKGROUND: Comorbidity is increasingly common in kidney transplant recipients, yet the implications for transplant outcomes are not fully understood. We analyzed the relationship between recipient comorbidity and survival outcomes in a UK-wide prospective cohort study-Access to Transplantation and Transplant Outcome Measures (ATTOM). METHODS: A total of 2100 adult kidney transplant recipients were recruited from all 23 UK transplant centers between 2011 and 2013. Data on 15 comorbidities were collected at the time of transplantation. Multivariable Cox regression models were used to analyze the relationship between comorbidity and 2-year graft survival, patient survival, and transplant survival (earliest of graft failure or patientdeath) for deceased-donor kidney transplant (DDKT) recipients (n = 1288) and living-donor kidney transplant (LDKT) recipients (n = 812). RESULTS: For DDKT recipients, peripheral vascular disease (hazard ratio [HR] 3.04, 95% confidence interval [CI]: 1.37-6.74; P = 0.006) and obesity (HR 2.27, 95% CI: 1.27-4.06; P = 0.006) were independent risk factors for graft loss, while heart failure (HR 3.77, 95% CI: 1.79-7.95; P = 0.0005), cerebrovascular disease (HR 3.45, 95% CI: 1.72-6.92; P = 0.0005), and chronic liver disease (HR 4.36, 95% CI: 1.29-14.71; P = 0.018) were associated with an increased risk of mortality. For LDKT recipients, heart failure (HR 3.83, 95% CI: 1.15-12.81; P = 0.029) and diabetes (HR 2.23, 95% CI: 1.03-4.81; P = 0.042) were associated with poorer transplant survival. CONCLUSIONS: The key comorbidities that predict poorer 2-year survival outcomes after kidney transplantation have been identified in this large prospective cohort study. The findings will facilitate assessment of individual patient risks and evidence-based decision making.
Authors: Vital Hevia; Victoria Gómez; Manuel Hevia; Javier Lorca; Marta Santiago; Ana Dominguez; Sara Álvarez; Víctor Díez; Cristina Gordaliza; Francisco Javier Burgos Journal: Curr Urol Rep Date: 2020-02-04 Impact factor: 3.092
Authors: Makayla Cordoza; Brittany Koons; Michael L Perlis; Brian J Anderson; Joshua M Diamond; Barbara Riegel Journal: Transplant Rev (Orlando) Date: 2021-09-14 Impact factor: 3.943
Authors: Tambi Jarmi; Aaron C Spaulding; Abdullah Jebrini; David M Sella; Lauren F Alexander; Samuel Nussbaum; Mira Shoukry; Launia White; Hani M Wadei; Houssam Farres Journal: World J Surg Date: 2022-07-19 Impact factor: 3.282
Authors: Andrea Gibbons; Janet Bayfield; Marco Cinnirella; Heather Draper; Rachel J Johnson; Gabriel C Oniscu; Rommel Ravanan; Charles Tomson; Paul Roderick; Wendy Metcalfe; John L R Forsythe; Christopher Dudley; Christopher J E Watson; J Andrew Bradley; Clare Bradley Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692