The Benefit of Kidney Transplantation over the Waitlist Depends on the Patient's Comorbidities

The Benefit of Kidney Transplantation over the Waitlist Depends on the Patient’s Comorbidities

A. Andrade Izquierdo¹, J. V. Reusing Jr¹, V. Onusic¹, F. Agena¹, F. C. Lemos¹, F. de Paula¹, F. Gerab², E. David-Neto¹

¹Renal Transplantation Service, Hospital das Clínicas - University of São Paulo School of Medicine, Sao Paulo, Brazil, ²Department of Mathematics, FEI University, Sao Paulo, Brazil

Meeting: 2019 American Transplant Congress

Abstract number: 540

Keywords: Mortality, Waiting lists

Session Information

Session Name: Concurrent Session: Kidney: Cardiovascular and Metabolic III

Session Type: Concurrent Session

Date: Tuesday, June 4, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 5:18pm-5:30pm

Location: Ballroom C

*Purpose: This study aimed to determine the impact of different comorbidities to the survival benefit of Kidney Transplantation (KTx) compared to waitlisted (WL) patients in short and long term of follow-up (FU).

*Methods: We retrospectively analyzed the records of WL patients for KTx from January 1, 2007 to December 31, 2012. Regular statistical analysis was performed. Time dependent Cox regression model were used to determine the initial and lower risk of death after KTx compared with WL. The final analysis included 1692 patients (pts) with a median FU of 3.9 (IQ=2.9-5.5) years.

*Results: 566 pts (34%) remained WL, while 768 (45%) were transplanted and 358 (21%) died WL. When all pts were included, the initial hazard risk of death (HRD) after KTx was 2.21; p=0.001 in the first 120 days.Thereafter, the HRD declined to 0.27; p<0.001. For pts without comorbidities the HRD was 6-fold higher in the first 20 days (HR=6.04; p<0.01) and progressively declined reaching equallity at 75 days. Thereafter, the HRD was 0.21 (p<0.001).

Pts with Diabetes and Coronary artery disease had higher initial HRD (HR=2.15; p=0.026 and HR=2.22; p=0.037, respectively) and was equal at 175 and 200 days, respectively. Thereafter the HRD was lower in these two comorbidity groups. For pts with Peripheral Vascular Disease the initial HRD was 3.2-fold higher in the first 250 days (HR=3.23; p=0.019). Thereafter, it decreased to 0.33 (p=0.002). Congestive heart failure showed the highest initial HRD among all comorbidities (HR=7.40; p=0.07), but this HRD declined rapidly, reaching equality at 110 days and reached 0.26 ( p=0.001) thereafter.

*Conclusions: This study identified that the time and size of HRD between KTx and WL patients varies depending upon the patient´s comorbidities. The assesment of mortality risk based on individual comorbidities can help physicians to counseling patients about their treatments options and satisfies the principle of autonomy.

To cite this abstract in AMA style:

Izquierdo AAndrade, Jr JVReusing, Onusic V, Agena F, Lemos FC, Paula Fde, Gerab F, David-Neto E. The Benefit of Kidney Transplantation over the Waitlist Depends on the Patient’s Comorbidities [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-benefit-of-kidney-transplantation-over-the-waitlist-depends-on-the-patients-comorbidities/. Accessed November 22, 2024.

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