Abstract: SA-PO073
Patients with a Failed Transplant Derive a Greater Survival Benefit from Transplantation Than Primary Transplant Recipients
Session Information
- Transplantation: Recipient and Donor Assessment
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Clark, Stephanie, Providence Health Care, Vancouver, British Columbia, Canada
- Abdalla, Ahad, Providence Health Care, Vancouver, British Columbia, Canada
- Gill, Jagbir, St. Paul's Hospital, West Vancouver, British Columbia, Canada
- Gill, John S., (St. Paul's Hospital/University of British Columbia), Vancouver, British Columbia, Canada
Background
The organ shortage demands evidence to support the use of deceased donor kidneys in higher risk groups. Repeat transplant recipients have a higher risk of allograft failure than first transplant recipients.
Methods
Using data from the United States Renal Data System between 2000-2016 we determined the relative risk of death in adult patients wait-listed for a first (n=334,162) or repeat (n= 26,815) deceased donor kidney transplant using multivariate non-proportional hazards analyses in which transplantation was treated as a time dependent co-variate. The models adjusted for differences in patient age, sex, race, cause of ESRD, comorbid conditions and year of wait-listing.
Results
The figure shows the relative risk of death in patients who received a first or repeat transplant at different time points after transplantation compared to similar patients (i.e. either first or repeat wait-list candidates) who remained on dialysis. Early after transplantation, first transplant recipients had a higher risk of death compared to first transplant candidates who remained on dialysis; this risk declined with time after transplantation. In contrast repeat transplant recipients had an immediate decreased risk of death compared to failed transplant recipients who remained on dialysis and this risk continued to decrease over time.
Accordingly the time to equal risk of death compared to continued treatment with dialysis was 105 days in first transplant recipients versus 0 days in repeat transplant recipients; and the time to equal survival compared to treatment with dialysis was greater in first transplant recipients than in repeat transplant recipients.
Conclusion
Transplantation is associated with a greater survival benefit in repeat transplant candidates. Further studies are needed to determine whether current wait-listing practices of patients with a failed transplant are overly restrictive.
Funding
- Government Support - Non-U.S.