Rachel Hellemans1, Anneke Kramer2, Johan De Meester3, Frederic Collart4, Dirk Kuypers5, Michel Jadoul6, Steven Van Laecke7, Alain Le Moine8, Jean-Marie Krzesinski9, Karl Martin Wissing10, Kim Luyckx11, Marieke van Meel12, Erwin de Vries12, Ineke Tieken12, Serge Vogelaar12, Undine Samuel13, Daniel Abramowicz1, Vianda S Stel2, Kitty J Jager2. 1. Department of Nephrology, Antwerp University Hospital, Edegem, Belgium. 2. Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. 3. Nederlandstalige Belgische Vereniging voor Nefrologie, Sint-Niklaas, Belgium. 4. Groupement des Néphrologues Francophones de Belgique, Liège, Belgium. 5. Department of Nephrology, University Hospitals Leuven, Leuven, Belgium. 6. Département de Néphrologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium. 7. Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium. 8. Département de Néphrologie, Hôpital Erasme-Université Libre de Bruxelles, Bruxelles, Belgium. 9. Centre Hospitalier Universitaire de Liège, Service de Néphrologie, Liège, Belgium. 10. Department of Nephrology, Universitair Ziekenhuis Brussel, Brussel, Belgium. 11. Department of Informatics, Antwerp University Hospital, Edegem, Belgium. 12. Eurotransplant International Foundation, Leiden, The Netherlands. 13. Eurotransplant International Foundation, Leiden, The Netherlands.
Abstract
BACKGROUND: Changes in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis. METHODS: We analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. The primary outcome was mortality during the median waiting time plus 3 years of follow-up after transplantation or with continued dialysis. Outcomes were analysed separately for standard criteria donor (SCD) and expanded criteria donor (ECD) kidney transplants. We adjusted survival analyses for recipient age (20-44, 45-64 and ≥65 years), sex and diabetes as the primary renal disease. RESULTS: Among patients ≥65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2-19.9] with SCD transplantation, 20.5% (95% CI 16.1-24.6) with ECD transplantation and 24.6% (95% CI 19.4-29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups. CONCLUSIONS: The results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small.
BACKGROUND: Changes in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis. METHODS: We analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. The primary outcome was mortality during the median waiting time plus 3 years of follow-up after transplantation or with continued dialysis. Outcomes were analysed separately for standard criteria donor (SCD) and expanded criteria donor (ECD) kidney transplants. We adjusted survival analyses for recipient age (20-44, 45-64 and ≥65 years), sex and diabetes as the primary renal disease. RESULTS: Among patients ≥65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2-19.9] with SCD transplantation, 20.5% (95% CI 16.1-24.6) with ECD transplantation and 24.6% (95% CI 19.4-29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups. CONCLUSIONS: The results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small.
Authors: Vasiliki Tsarpali; Karsten Midtvedt; Kjersti Lønning; Tomm Bernklev; Anders Åsberg; Haris Fawad; Nanna von der Lippe; Anna Varberg Reisæter; Kjetil Røysland; Kristian Heldal Journal: Transplant Direct Date: 2022-03-23