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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.


Mortality (HR) according to transplant status and CCI group Multivariate analysis of 3174 patients, with patients having a CCI of 2 and never transplanted as the reference (HR = 1).
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Figure 5: Mortality (HR) according to transplant status and CCI group Multivariate analysis of 3174 patients, with patients having a CCI of 2 and never transplanted as the reference (HR = 1).

Mentions: Mortality risk increased significantly with increasing CCI value. The mortality risk of the 22% of the patients, who had a CCI of 5 or more at WL entry, was more than 100% higher than patients with a CCI of 2. The addition of an interaction between transplantation status and CCI category improved the model significantly (Likelihood ratio test: P = 0.02), implying a separate effect of transplantation status for each CCI group (Figure 5). Changing reference category to patients with CCI of 5 or greater and transplant status 0 (WL), we found that the HR for DDT was 0.28 (0.20-0.39) and for LDT 0.33 (0.21-0.52).


Survival Benefit in Renal Transplantation Despite High Comorbidity
Mortality (HR) according to transplant status and CCI group Multivariate analysis of 3174 patients, with patients having a CCI of 2 and never transplanted as the reference (HR = 1).
© Copyright Policy
Related In: Results  -  Collection

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

Figure 5: Mortality (HR) according to transplant status and CCI group Multivariate analysis of 3174 patients, with patients having a CCI of 2 and never transplanted as the reference (HR = 1).
Mentions: Mortality risk increased significantly with increasing CCI value. The mortality risk of the 22% of the patients, who had a CCI of 5 or more at WL entry, was more than 100% higher than patients with a CCI of 2. The addition of an interaction between transplantation status and CCI category improved the model significantly (Likelihood ratio test: P = 0.02), implying a separate effect of transplantation status for each CCI group (Figure 5). Changing reference category to patients with CCI of 5 or greater and transplant status 0 (WL), we found that the HR for DDT was 0.28 (0.20-0.39) and for LDT 0.33 (0.21-0.52).

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.