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Survival Benefit in Renal Transplantation Despite High Comorbidity

View Article: PubMed Central - PubMed

ABSTRACT

Background: The age and degree of comorbidity among transplant candidates is increasing. Knowledge of survival benefit in relation to recipient age and comorbidity is important, considering the scarcity of organs available for transplantation. The aim of the present study was to analyze the chances and survival benefit of transplantation among patients in different age groups and with different degrees of comorbidity score at the time of entering the waiting list.

Methods: Data from the Danish Nephrology Registry and Scandiatransplant were merged. Charlson Comorbidity Index scores were derived from the National Danish Admissions Registry. Study period is from January 1, 1995, to December 31, 2011. A multistate model was used to analyze the chance of having a renal transplantation and the effect of transplantation in different patients groups.

Results: Patients older than 65 years and patients with high comorbidity score had a decreased chance of being transplanted. However, if patients older than 65 years were transplanted with deceased donor, the mortality risk was reduced by 55% (hazard rate, 0.45 (0.26-0.75). In patients with a comorbidity score of 5 or greater, receiving a deceased donor transplant reduced the mortality risk by 72% (hazard rate, 0.28 (0.20-0.39). The overall survival benefit was 62% versus 70% in deceased versus living donor transplanted patients.

Conclusions: Poor health and old age reduced the chance of being transplanted. However, patients older than 65 years and patients with high comorbidity still had a survival benefit from renal transplantation.

No MeSH data available.


Multi state model DDT, LDT.
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Figure 1: Multi state model DDT, LDT.

Mentions: We analyzed data by using a multistate model including both DDT and living donor transplantation (LDT). At any given time after the first WL entry, a patient is in 1 of 3 main stages: (1) still on the WL, (2) transplanted with a deceased or a living donor, or (3) dead. The transition between stages is illustrated in Figure 1. In our analyses, withdrawal from the WL, graft failure (meaning that the patient returned to dialysis treatment), or repeat transplants were ignored.


Survival Benefit in Renal Transplantation Despite High Comorbidity
Multi state model DDT, LDT.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120769&req=5

Figure 1: Multi state model DDT, LDT.
Mentions: We analyzed data by using a multistate model including both DDT and living donor transplantation (LDT). At any given time after the first WL entry, a patient is in 1 of 3 main stages: (1) still on the WL, (2) transplanted with a deceased or a living donor, or (3) dead. The transition between stages is illustrated in Figure 1. In our analyses, withdrawal from the WL, graft failure (meaning that the patient returned to dialysis treatment), or repeat transplants were ignored.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The age and degree of comorbidity among transplant candidates is increasing. Knowledge of survival benefit in relation to recipient age and comorbidity is important, considering the scarcity of organs available for transplantation. The aim of the present study was to analyze the chances and survival benefit of transplantation among patients in different age groups and with different degrees of comorbidity score at the time of entering the waiting list.

Methods: Data from the Danish Nephrology Registry and Scandiatransplant were merged. Charlson Comorbidity Index scores were derived from the National Danish Admissions Registry. Study period is from January 1, 1995, to December 31, 2011. A multistate model was used to analyze the chance of having a renal transplantation and the effect of transplantation in different patients groups.

Results: Patients older than 65 years and patients with high comorbidity score had a decreased chance of being transplanted. However, if patients older than 65 years were transplanted with deceased donor, the mortality risk was reduced by 55% (hazard rate, 0.45 (0.26-0.75). In patients with a comorbidity score of 5 or greater, receiving a deceased donor transplant reduced the mortality risk by 72% (hazard rate, 0.28 (0.20-0.39). The overall survival benefit was 62% versus 70% in deceased versus living donor transplanted patients.

Conclusions: Poor health and old age reduced the chance of being transplanted. However, patients older than 65 years and patients with high comorbidity still had a survival benefit from renal transplantation.

No MeSH data available.