Background: Kidney transplantation is associated with lower mortality and improved quality of life for patients with end stage renal disease (ESRD). Survival in dialysis and transplant populations have improved over the last decades and acceptance onto transplant programmes has become more liberal. The aim of this study was to investigate the benefit of renal transplantation in the current era and to identify factors influencing the degree of benefit compared to waiting on dialysis.

Methods: Single centre review of prospectively collected data of adult patients who were activated on the waiting list for renal transplantation from 01 Nov 2005 till 31 Mar 2015. All continuous data are presented as median (interquartile range).

Results: During a follow-up period of 51 months (28.1/82.4), 2219 patients were activated in our transplant waiting list (age 52.4 (42.3/61.6), 64.5% males). In this multi-ethnic group of patients (Caucasians 38.8%, South-Asians 30.7%, Afro-Caribbean 17%) glomerulonephritis (26.1%) and diabetic nephropathy (DN) (23.2%) were the most frequent causes of ESRD. At the end of the follow-up 1272 received a renal transplant (52.1% from a live donor). Patients that received a renal transplant were younger, aged 49.0 (39.0/58.7) vs 57.1 (47.7/64.9) compared to the wait-listed group. The median waiting time for a deceased-donor graft was 32.1 months (15.8/47.8). Multivariate cox regression analysis showed that transplantation (HR 0.63, 95% CI 0.47–0.84, p=0.001) and in particular pre-emptive transplantation (HR 0.49, 95% CI 0.84-0.28, p=0.01) as well as younger age on activation (HR 0.96, 95% CI 0.97–0.95, p <0.001) have a positive impact on overall survival. DN (HR: 2.01, 95% CI 1.6–2.6, p <0.001) and dialysis vintage per month (HR: 1.03, 95% CI 1.01–1.05, p <0.001) were significant risk factors for mortality.

Conclusion: This study indicates significantly lower mortality in the transplant cohort compared to the waitlisted. The medium term survival advantage associated with renal transplantation is evident in this multi-ethnic cohort of patients with no difference between different ethnic groups. Pre-emptive transplantation in younger patients offers the most significant survival advantage.

CITATION INFORMATION: Spanos G, Duncan N, Brookes P, Singh S, Goodall D, Moutzouris D, Evangelou E, Loucaidou M. Kidney Transplantation Offers a Significant Survival Advantage Compared to Waitlisting, a Single Centre Experience. Am J Transplant. 2016;16 (suppl 3).

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