Kidney Transplant Patient Preferences and Trade-Offs for Outcomes After Transplantation.

M. Howell,^1,2 G. Wong,^1,2,3 J. Rose,⁴ A. Tong,^1,2 J. Craig,^1,2 K. Howard.²

¹Centre for Kidney Research, The Childrens Hospital at Westmead, Westmead, NSW, Australia
²School of Public Health, University of Sydney, Sydney, NSW, Australia
³Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
⁴Institute of Choice, University of South Australia, North Sydney, NSW, Australia.

Meeting: 2016 American Transplant Congress

Abstract number: A284

Keywords: Immunosuppression, Kidney transplantation, Outcome, Quality of life

Session Information

Session Name: Poster Session A: Poster Session III: Kidney Complications-Other

Session Type: Poster Session

Date: Saturday, June 11, 2016

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

Aim: To evaluate preferences and trade-offs patients may accept to avoid adverse outcomes of long-term immunosuppression. Background: Patient preferences in clinical decisions are increasingly relevant, yet transplant patient perspectives through structured, quantified preference elicitation methods are unknown. Methods: Preferences and trade-offs between graft duration and the risk of dying, cancer, cardiovascular disease (CVD), diabetes, infection, anxiety/depression, diarrhea/nausea, and weight gain, was assessed using a best-worst scaling survey. Participants, recruited from clinics, were shown 10 scenarios with varying outcome probabilities and years of graft duration and asked to choose best, next-best, worst and next-worst outcomes. Responses were analyzed with multinominal-logit models Results: Ninety-three patients (age 18-69 years, transplant duration 0.9-31 years) completed the survey. The most important outcome was death followed by (in order), duration of graft survival, cancer, CVD, anxiety/depression, infection, diarrhea/nausea, diabetes and weight gain. A 0% risk of dying (β=1.0 95%CI:0.92,1.08) was more important than 25 years of graft survival (β=0.8 95%CI:0.64,0.78). One year graft survival (β=0.0 95%CI:-0.05,0.05) was worse than any other outcome including 100% risk of dying (β=0.19 95%CI:0.13,0.24). Preferences varied with age, gender, comorbidities, dialysis and transplant duration, and number of transplants (Fig 1). Respondents were willing to trade 2.8 (95%CI:1.8,4.1), 1.5 (95%CI:1.0,2.2), 1.1 (95%CI:0.8,1.7) and 0.7 (95%CI:0.5,1.1) years graft survival to achieve a 0% probability of cancer, dying, CVD and anxiety/depression respectively. Conclusions: Preferences and trade-offs suggest that 5 years graft survival is worse than dying and serious outcomes including cancer. Long-term clinical studies are needed to support patient preferences and shared-decisions.

CITATION INFORMATION: Howell M, Wong G, Rose J, Tong A, Craig J, Howard K. Kidney Transplant Patient Preferences and Trade-Offs for Outcomes After Transplantation. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Howell M, Wong G, Rose J, Tong A, Craig J, Howard K. Kidney Transplant Patient Preferences and Trade-Offs for Outcomes After Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplant-patient-preferences-and-trade-offs-for-outcomes-after-transplantation/. Accessed November 22, 2024.

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