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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.


Related in: MedlinePlus

Illustration of model fit. Cumulative hazards for mortality in patients remaining on the waiting list compared to transplanted patients based on stratified versus univariate Cox regression (common baseline).
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Figure 2: Illustration of model fit. Cumulative hazards for mortality in patients remaining on the waiting list compared to transplanted patients based on stratified versus univariate Cox regression (common baseline).

Mentions: First, we analyzed the effects of baseline (fixed) covariates on time to transplantation (meaning the chance of being transplanted), where the cause-specific hazard is modelled by Cox regression (Figure 1, transition 1- to >2). Second, we analyzed the effects of baseline (fixed) covariates as well as the effect of time-dependent transplantation status on mortality by Cox regression (transition 1 to >3 and 2 to >3 combined). Figure 2 illustrates the model fit by plotting cumulative hazards based on a (univariate) Cox model with common baseline hazard for both LDT and DDT status against separate cumulative hazard estimates from a stratified Cox mode without covariates (for transition 1 to >3, patients are censored at time of transplantation; for transition 2 to >3, patients enter at time of transplantation [delayed entry]). Additionally, we explored interactions between transplantation status and age category, comorbid category, and cohort separately in the multivariable setting.


Survival Benefit in Renal Transplantation Despite High Comorbidity
Illustration of model fit. Cumulative hazards for mortality in patients remaining on the waiting list compared to transplanted patients based on stratified versus univariate Cox regression (common baseline).
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Illustration of model fit. Cumulative hazards for mortality in patients remaining on the waiting list compared to transplanted patients based on stratified versus univariate Cox regression (common baseline).
Mentions: First, we analyzed the effects of baseline (fixed) covariates on time to transplantation (meaning the chance of being transplanted), where the cause-specific hazard is modelled by Cox regression (Figure 1, transition 1- to >2). Second, we analyzed the effects of baseline (fixed) covariates as well as the effect of time-dependent transplantation status on mortality by Cox regression (transition 1 to >3 and 2 to >3 combined). Figure 2 illustrates the model fit by plotting cumulative hazards based on a (univariate) Cox model with common baseline hazard for both LDT and DDT status against separate cumulative hazard estimates from a stratified Cox mode without covariates (for transition 1 to >3, patients are censored at time of transplantation; for transition 2 to >3, patients enter at time of transplantation [delayed entry]). Additionally, we explored interactions between transplantation status and age category, comorbid category, and cohort separately in the multivariable setting.

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.


Related in: MedlinePlus