Lifetime Survival Estimates Following Solid Organ Transplantation in the United States
1RTI Health Solutions, Research Triangle Park, NC, 2Chronic Disease Research Group, Minneapolis, MN, 3Atara Biotherapeutics, South San Francisco, CA, 4Atara Biotherapeutics, Thousand Oaks, CA
Meeting: 2020 American Transplant Congress
Abstract number: C-208
Keywords: Epstein-Barr virus (EBV), Post-transplant lymphoproliferative disorder (PTLD)
Session Information
Session Name: Poster Session C: Non-Organ Specific: Economics & Ethics
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: The Scientific Registry of Transplant Recipients (SRTR) contains detailed patient and graft survival data for all solid organ transplants (SOT) in the United States from 1990 onwards. While follow-up extends over 25 years, mean estimates of lifetime survival following SOT are not available, since many patients remained alive at the end of follow-up. Objectives: In this study, we sought to estimate mean overall survival following the most prevalent single SOTs: kidney, liver, heart, and lung.
*Methods:
To account for changes in patient survival due to modern immunosuppression, SRTR data was used starting from 2000 through 2018. Survival analyses were conducted for both pediatric (<18 years of age) and adult (≥18 years of age) populations where possible. First, parametric survival analyses were carried out using 6 distributions (exponential, generalized gamma, Gompertz, log-logistic, log-normal, and Weibull). Next, flexible cubic splines were fit with 3 parameterizations (log-cumulative hazard, log-cumulative odds, inverse normal) and the number of knots increased until fit statistics (AIC and BIC) did not improve. Goodness-of-fit tests and visual inspection of fitted curves overlaid on Kaplan-Meier plots were used to determine the best-fit models. Extrapolated tails were corrected where general population hazards were greater than those estimated for SOT and if long-term pediatric hazards were lower than adult projections.
*Results: Survival data for 278,955 kidney, 105,438 liver, 43,122 heart, and 29,813 lung transplants were analyzed. Flexible cubic splines fit best due to complex hazards. Survival was longest following kidney transplant and shortest following lung transplant. Mean overall survival estimates for pediatric and adult populations were 49.5 and 20.6 years for kidney, 51.5 and 18.2 years for liver, 32.7 and 16.3 years for heart transplants, and 10.1 and 9.1 years for lung transplants.
*Conclusions: Lifetime survival projections following SOT estimated by this analysis can be used by decision makers where means are preferred over medians (e.g., population projections, budgetary estimates, cost-effectiveness models).
To cite this abstract in AMA style:
Graham C, Skeans M, Ahn Y, Watson C, Barlev A. Lifetime Survival Estimates Following Solid Organ Transplantation in the United States [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/lifetime-survival-estimates-following-solid-organ-transplantation-in-the-united-states/. Accessed November 21, 2024.« Back to 2020 American Transplant Congress