Abstract: FR-PO1017

Intensive Home Hemodialysis Survival Is Comparable to Deceased Donor Kidney Transplant

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Nishio-Lucar, Angie G., University of Virginia HS, Charlottesville, Virginia, United States
  • Lyons, Genevieve R, University of Virginia HS, Charlottesville, Virginia, United States
  • Bose, Subhasish, Lynchburg Nephrology Physicians, Lynchburg, Virginia, United States
  • Lockridge, Robert S., University of Virginia HS, Charlottesville, Virginia, United States
Background

Kidney transplant (KT) is the treatment of choice for end-stage renal disease (ESRD) but, unfortunately, kidney donors are scarce. A prior Canadian study suggested intensive home hemodialysis (IHHD) had similar survival to deceased donor (DD) KT. Herein; we compare the survival of a large cohort of IHHD patients with kidney transplant recipients (KTR) in the same U.S. region.

Methods

We included all consecutive adult patients who received a first KT or started IHHD in the same Virginia region between October 1997 and June 2014. We obtained data on KTR from the Scientific Registry of Transplant Recipients and data on IHHD patients from Lynchburg Nephrology Physicians practice in Lynchburg, Virginia. We excluded recipients of en-bloc kidneys, multi-organ transplants and subsequent KT. Those receiving other home dialysis therapies, in-center hemodialysis (HD) or home HD getting < 20hrs/week or <4 sessions/week were also excluded. Kaplan-Meier method was used to estimate the overall survival (OS) among different modalities: IHHD versus living donor (LD) and DD KT. Adjusted hazard ratios (HR) were estimated using multivariate Cox proportional hazards regression.

Results

We identified 3097 KTR and 116 IHHD patients. Both cohorts had similar proportion of females (40.5% KTR vs 41.4% IHHD), African Americans (48.9% vs 50.9%) and diabetics (36.51% vs 37.1%). Compared to KTR, IHHD patients were more likely to be obese and have history of malignancy. LD KTR had the highest patient survival (Figure 1). At 5 years, the survival probability in IHHD patients was 79% (CI 0.69-0.90) compared to 84% (CI 0.82-0.86) in DD KTR, however the HRs did not significantly differ (HR 1.05, CI 0.68-1.62, p=0.837) after adjusting for ESRD cause, sex, age, and peripheral vascular disease.

Conclusion

In this study, survival of IHHD patients was not statistically different from DD KTR suggesting IHHD could be a reasonable alternative to DD KT.
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