Lynda Cheddani1,2, Sophie Liabeuf2,3,4, Marie Essig1, Renaud Snanoudj2,5, Christian Jacquelinet2, Clarisse Kerleau6, Marie Metzger2, Beverley Balkau2, Tilman B Drüeke2, Maryvonne Hourmant6, Ziad A Massy1,2. 1. Division of Nephrology, Ambroise Paré University Medical Center, APHP, Boulogne Billancourt, F-92100 Paris, France. 2. Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France. 3. Division of Clinical Pharmacology, Clinical Research Department, Amiens University Medical Center, F-80054 Amiens, France. 4. EA 7517, MP3CV Laboratory, CURS, Jules Verne University of Picardie, F-80054 Amiens, France. 5. Division of Nephrology, Hôpital Foch, F-92150 Suresnes, France. 6. Division of Nephrology, Institut de Transplantation Urologie Néphrologie, Nantes University Medical Center, F-44000 Nantes, France.
Abstract
BACKGROUND: Although kidney transplantation prolongs survival relative to dialysis, it is associated with a higher death rate than in the general population. The objective of the present study was to assess and compare the risk of mortality and frequency of non-lethal cardiovascular (CV) events in kidney transplant recipients (KTRs) beyond 1 year after successful transplantation versus patients with chronic kidney disease (CKD) using propensity score-matched analysis of estimated glomerular filtration rate (eGFR) and other parameters. METHODS: After propensity score matching, we studied 340 KTRs from the French Données Informatisées et Validées en Transplantation cohort and 605 non-transplant patients with CKD (CKDps) from the French Chronic Kidney Disease-Renal Epidemiology and Information Network cohort. The mean ± standard deviation eGFR was 42 ± 13 and 41 ± 12 mL/min/ 1.73 m2, respectively (P = 0.649). Descriptive data were completed by a survival analysis with Cox regression models. RESULTS: After a median follow-up period of 2.8 years (KTRs 2.0 years, CKDp 2.9 years), 71 deaths were recorded (31 and 40 in the KTR and CKD groups, respectively). Univariate analysis showed that KTRs had a significantly greater risk of mortality than CKDps. In multivariable analysis, KTRs were found to have a 2.7-fold greater risk of mortality [hazard ratio 2.7 (95% confidence interval 1.6-4.7); P = 0.005]. There was no between-group difference concerning the risk of CV events (P = 0.448). CV death rates in KTRs (29.0%) approximated those of CKDps (22.5%), whereas death rates due to infections were higher in KTRs (19.4% versus 10.0%). CONCLUSION: Beyond 1 year after transplantation, KTRs, who possibly had a longer CKD history, had a significantly greater mortality risk than eGFR-matched CKDps. The excess risk was not associated with CV events.
BACKGROUND: Although kidney transplantation prolongs survival relative to dialysis, it is associated with a higher death rate than in the general population. The objective of the present study was to assess and compare the risk of mortality and frequency of non-lethal cardiovascular (CV) events in kidney transplant recipients (KTRs) beyond 1 year after successful transplantation versus patients with chronic kidney disease (CKD) using propensity score-matched analysis of estimated glomerular filtration rate (eGFR) and other parameters. METHODS: After propensity score matching, we studied 340 KTRs from the French Données Informatisées et Validées en Transplantation cohort and 605 non-transplant patients with CKD (CKDps) from the French Chronic Kidney Disease-Renal Epidemiology and Information Network cohort. The mean ± standard deviation eGFR was 42 ± 13 and 41 ± 12 mL/min/ 1.73 m2, respectively (P = 0.649). Descriptive data were completed by a survival analysis with Cox regression models. RESULTS: After a median follow-up period of 2.8 years (KTRs 2.0 years, CKDp 2.9 years), 71 deaths were recorded (31 and 40 in the KTR and CKD groups, respectively). Univariate analysis showed that KTRs had a significantly greater risk of mortality than CKDps. In multivariable analysis, KTRs were found to have a 2.7-fold greater risk of mortality [hazard ratio 2.7 (95% confidence interval 1.6-4.7); P = 0.005]. There was no between-group difference concerning the risk of CV events (P = 0.448). CV death rates in KTRs (29.0%) approximated those of CKDps (22.5%), whereas death rates due to infections were higher in KTRs (19.4% versus 10.0%). CONCLUSION: Beyond 1 year after transplantation, KTRs, who possibly had a longer CKD history, had a significantly greater mortality risk than eGFR-matched CKDps. The excess risk was not associated with CV events.
Authors: Lynda Cheddani; Jean Philippe Haymann; Sophie Liabeuf; Nahid Tabibzadeh; Jean-Jacques Boffa; Emmanuel Letavernier; Marie Essig; Tilman B Drüeke; Michel Delahousse; Ziad A Massy Journal: Clin Kidney J Date: 2020-09-03