David B Leeser1, Alvin G Thomas2,3, Ashton A Shaffer2,4, Jeffrey L Veale2, Allan B Massie2, Matthew Cooper5, Sandip Kapur6, Nicole Turgeon7, Dorry L Segev2,4, Amy D Waterman8,9, Stuart M Flechner10. 1. Department of Surgery, East Carolina University, Greenville, North Carolina; leeserd17@ecu.edu. 2. Department of Surgery and. 3. Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina. 4. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. 5. Medstar Georgetown Transplant Institute, Washington, DC. 6. Department of Surgery, Cornell University, New York, New York. 7. Department of Surgery, Dell School of Medicine, University of Texas at Austin, Austin, Texas. 8. Department of Nephrology, University of California, Los Angeles, Los Angeles, California. 9. Terasaki Research Institute, Los Angeles, California; and. 10. Department of Urology, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND AND OBJECTIVES: In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m2, diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m2), and transplant factors (zero HLA mismatch). RESULTS: National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1-5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients. CONCLUSIONS: Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.
BACKGROUND AND OBJECTIVES: In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m2, diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m2), and transplant factors (zero HLA mismatch). RESULTS: National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1-5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients. CONCLUSIONS: Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.
Authors: D L Segev; J L Veale; J C Berger; J M Hiller; R L Hanto; D B Leeser; S R Geffner; S Shenoy; W I Bry; S Katznelson; M L Melcher; M A Rees; E N S Samara; A K Israni; M Cooper; R J Montgomery; L Malinzak; J Whiting; D Baran; J I Tchervenkov; J P Roberts; J Rogers; D A Axelrod; C E Simpkins; R A Montgomery Journal: Am J Transplant Date: 2011-01-10 Impact factor: 8.086
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Authors: Stuart M Flechner; Alvin G Thomas; Matthew Ronin; Jeffrey L Veale; David B Leeser; Sandip Kapur; John D Peipert; Dorry L Segev; Macey L Henderson; Ashton A Shaffer; Matthew Cooper; Garet Hil; Amy D Waterman Journal: Am J Transplant Date: 2018-04-30 Impact factor: 8.086
Authors: Christine M Durand; Mary G Bowring; Alvin G Thomas; Lauren M Kucirka; Allan B Massie; Andrew Cameron; Niraj M Desai; Mark Sulkowski; Dorry L Segev Journal: Ann Intern Med Date: 2018-04-17 Impact factor: 25.391
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