Abstract: TH-PO989

Provision of Highly Specialized Aftercare by the Transplant Center Strongly Improves Patient and Allograft Survival in Long-Term Follow-Up After Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Schachtner, Thomas, Charite Campus Virchow Clinic, Berlin, Germany
  • Otto, Natalie M., Charité Berlin, Berlin, Germany
  • Reinke, Petra, Charité, Campus Virchow Klinikum, Berlin, Germany
Background

Despite rapid medical advancements in the field of transplantation, mean kidney allograft survival remained at a standstill. If and to what extent a highly specialized and experienced aftercare of kidney transplant recipients (KTRs) impacts patient and allograft outcomes in long-term follow-up, however, remains mostly unknown.

Methods

We retrospectively analyzed 1328 KTRs between 1998 and 2015 with respect to patient and allograft survival. KTRs treated regularly in our transplant center in long-term follow-up were compared with KTRs followed by local nephrologists and general practitioners. KTRs that make no use of the transplant center provided aftercare, were assessed by a questionnaire-based survey with respect to allograft survival and their reasons not to make use of it.

Results

In total 824 KTRs (62.0%) were followed in our transplant center and 504 KTRs (38.0%) were followed by local nephrologists. Multivariate analysis identified shorter distance to the transplant center (p<0.001), living donation (p<0.001), early registration to the waiting list (p=0.009), and shorter initial hospital stay (p=0.004) as independet factors for strong adherence to the transplant center. KTRs followed in our transplant center showed significantly better patient (72.7% vs. 50.4% after 15 years; p=0.001) and death-censored allograft survival (85.0% vs. 64.4% after 15 years; p<0.001) compared to KTRs followed by local nephrologists. These differences were equally observed in deceased and living donation. Reasons not to make use of the transplant center provided aftercare included distance (47%), prohibitively expensive costs (37%), no identifiable advantages (34%), and negative experiences (7%).

Conclusion

Our data strongly indicate that provision of aftercare by the transplant center is highly associated with superior patient and allograft survival. The observed wide differences may be attributed to highly specialized screening protocols, careful and critical guidance of immunosuppression, and more comprehensive medical care. Despite long distances, transplant centers, local nephrologists, and health insurances must encourage patients to make use of transplant center provided aftercare.