Kidney Week

Abstract: SA-PO042

Mortality and Morbidity in Kidney Transplant Recipients with a Failing Graft

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Quinn, Robert R., University of Calgary, Calgary, Alberta, Canada

Robert R. Quinn,

• Boyne, Devon J., University of Calgary, Calgary, Alberta, Canada

Devon J. Boyne,

• Austin, Peter, Institute for Clinical Evaluative Sciences, Toronto, Alberta, Canada

Peter Austin,

• Campbell, Patricia, University of Alberta, Edmonton, Alberta, Canada

Patricia Campbell,

• Hemmelgarn, Brenda, University of Calgary, Calgary, Alberta, Canada

Brenda Hemmelgarn,

• Knoll, Greg A., Ottawa Hospital, Ottawa, Ontario, Canada

Greg A. Knoll,

• Yilmaz, Serdar, University of Calgary, Calgary, Alberta, Canada

Serdar Yilmaz,

• Ravani, Pietro, University of Calgary, Calgary, Alberta, Canada

Pietro Ravani,

Background

There is little information on mortality and morbidity in kidney transplant recipients with a failing graft. Due to their history of renal disease and exposure to immunosuppression, recipients may be at higher risk of adverse outcomes compared to non-transplant controls with similar degree of chronic kidney disease.

Methods

We performed a retrospective study of kidney transplant recipients with a failing graft in Alberta, Canada (2002-2013), defined as ≥2 eGFR measurements between 15-30 mL/min/1.73 m² that were 90-365 days apart. We propensity-score matched (1:1) recipients with a failing graft to non-transplant patients on several demographic characteristics, clinical, and laboratory data. We used Cox regression to compare the hazard for death between the two groups and negative binomial regression to compare hospital admission rates.

Results

We identified 521 kidney transplant recipients with a failing graft and matched 487 (93%) of them to a non-transplant control. The median age of the cohort was 56 years (IQR 45-65) and 41% were women. Compared to matched non-transplant controls, kidney transplant recipients with a failing graft had a higher rate of death (hazard ratio 1.25, 95% CI 1.01-1.55; p=0.039) and hospitalization (rate ratio 1.72, 95% CI 1.44-2.06; p<0.001). Kidney transplant recipients also had significantly higher rates of hospitalization for cardiovascular events and infections, but not cancer.

Conclusion

A failing kidney transplant adds further mortality and morbidity burden to chronic kidney disease. This information may assist the discussion of prognosis in kidney transplant recipients with a failing graft and the design of strategies to minimize risks.

Figure. Kaplan-Meier estimated survival probabilities stratified by transplant status