Following implementation of KAS, deceased donor kidney transplant (DDKT) waitlist registrants with long dialysis vintage have high allocation priority. However, having survived for many years on dialysis, these patients may tolerate dialysis well; moreover, longer dialysis vintage is associated with worse post-transplant survival. As such, the survival benefit of DDKT for these patients is unknown.

METHODS: Using SRTR data 2002-2016 on 17,271 DDKT waitlist registrants who were active on the waitlist >10y past dialysis initiation, we studied the survival benefit of DDKT using the Mauger method, treating DDKT as a time-varying exposure and adjusting for candidate characteristics.

RESULTS: Among patients alive and waitlisted at 10y after dialysis initiation, 11, 13, and 15-year survival past dialysis initiation were 88.4%, 69.6%, and 55.4, respectively (Figure, left panel). A total of 4,315 registrants received DDKT >10 years after dialysis initiation. 1, 3, and 5-year post-DDKT patient survival were 95.3%, 89.4%, and 82.4% respectively (Figure, right panel). Past 30d post-transplant, DDKT was associated with substantially reduced mortality risk (HR = _0.51 0.69 _0.93 at 30-90d post-DDKT, _0.30 0.35 _0.41 at 1-3y post-DDKT, and _0.41 0.49 _0.57 at >5y post-DDKT, all p<0.02) (Table).

Among 13,690 patients alive and waitlisted at 15y after dialysis initiation, 16, 18, and 20-year survival past dialysis initiation were 89.0%, 73.2%, and 57.2%, respectively. A total of 734 registrants received DDKT >15y after dialysis initiation. 1, 3, and 5-year post-DDKT survival were 94.0%, 89.1%, and 80.4% respectively. Past 180d post-transplant, DDKT was associated with substantially reduced mortality risk (Table).

CONCLUSION: Patients with >10 years of dialysis vintage receive substantial survival benefit from DDKT. Since they receive high allocation priority under KAS, transplantation should be considered as a treatment modality even for patients who have never listed for DDKT.

CITATION INFORMATION: Massie A., Crews D., Purnell T., Garonzik-Wang J., Segev D. Transplant Benefit to Patients with Long Dialysis Vintage Am J Transplant. 2017;17 (suppl 3).

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