Abstract: SA-PO045
Is It Time to Switch? Comparing Transplant Outcomes Among Dialysis Modalities: Analysis from the United States Renal Data System (USRDS)
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
- Schreiber, Brittany Lauren, University of Texas Medical Branch, Galveston, Texas, United States
- Aleter, Omar A., University of Texas Medical Branch, Galveston, Texas, United States
- Chaudhary, Vishy, University of Texas Medical Branch, Galveston, Texas, United States
- Fischer, Wayne G., University of Texas Medical Branch, Galveston, Texas, United States
- Lal, Yasir, University of Texas Medical Branch, Galveston, Texas, United States
- Kassem, Hania, University of Texas Medical Branch, Galveston, Texas, United States
Background
The effect of pre-transplant dialysis modality (DM) on transplant (Tx) outcomes has been a topic of study for many years. However, studies have largely compared patients (pts) on a single modality, either hemodialysis (HD) or peritoneal dialysis (PD). Though still controversial, pts on PD have been shown to have a higher likelihood of Tx, shorter time to Tx, and higher recipient survival rates than pts on HD. It is unknown whether pts who switch from HD to PD benefit similarly. This question has become particularly important given the incentive provided by the prospective payment system dialysis bundle for transitioning pts to PD. The aim of our study was to compare the effect of DM, including pts who switch from HD to PD, on the likelihood of Tx, time to Tx and recipient survival.
Methods
Our study is a retrospective analysis of data obtained from the USRDS from May 2012 to December 2015. Pts were divided into 3 groups: HD only (n=637778), PD only (n=43733) and pts who switched from HD to PD (n=23816); pts who switched from PD to HD were excluded. Groups were then compared to determine the likelihood of Tx among each group. Groups were further divided into pts who had received a single kidney Tx to determine the effect of DM on time to Tx and recipient survival rate. Statistical analysis included Contingency Analysis for likelihood of Tx, Oneway ANOVA for time to Tx, Kaplan-Meier survival curves, and Cox Proportional Hazards for the effects of predictor variables on pts survival.
Results
Pts in the HD to PD group had a higher likelihood of Tx (5% absolute, p<0.01), shorter time to Tx (1.54 years, p<0.01), and higher recipient survival compared to the HD only group (p<0.01). Besides higher age upon dialysis initiation, the only baseline characteristic negatively affecting survival in the HD to PD group was the presence of diabetes. This group also had similar advantages over the PD only group except for likelihood of Tx.
Conclusion
Our study showed that pts who switched from HD to PD had a higher likelihood of Tx, shorter time to Tx and improved recipient survival compared to other DM. Given the potential benefit gained by pts on PD, switching to PD regardless of initial modality may lead to improved Tx outcomes.