Abstract: SA-PO013
Trends in Transplant Nephrectomy After Kidney Allograft Failure in the United States
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Airy, Medha, Baylor College of Medicine, Houston, Texas, United States
- Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background
Patients with end-stage kidney disease whose transplants have failed experience worse outcomes compared to those on dialysis not previously transplanted. Following allograft failure, transplant nephrectomy is commonly considered in patients with symptomatic rejection, infections, malignancy, or resistant anemia. Over the years, early allograft nephrectomies have declined due to improved short-term transplant outcomes, but information on the trends regarding nephrectomy among patients with later allograft failure is lacking. This study examined the trends over two decades in transplant nephrectomy following kidney allograft failure.
Methods
We used the US Renal Data System to identify all patients whose first kidney allograft failed >90 days after transplant and who had Medicare fee-for-service at the time. Patients were followed for any allograft nephrectomy within 1-year post-allograft failure. We used Cox proportional hazards models with year of allograft failure as the exposure of interest while adjusting for sociodemographic and health-related patient characteristics. Follow-up was censored at 1 year, loss of Medicare fee-for-service, re-transplantation, or death
Results
We included 29,496 patients whose first kidney transplant failed between 1996 and 2013. Multivariable-adjusted Cox models indicated non-significant hazard ratios (HR) for transplant nephrectomy between 1996 (referent) and 2006; thereafter, the rates of transplant nephrectomy declined considerably with HR of 0.85 (0.73, 1.00) for 2007 and 0.58 (0.49-0.69) for 2013
Conclusion
While adjusted rates of transplant nephrectomy were essentially static between 1996 and 2006, they have decreased considerably thereafter. The reasons for this trend are unclear but may reflect greater recognition of transplant nephrectomy-associated allosensitization.