Abstract: TH-OR128
Outcomes for Kidney Transplant Recipients with Hearing, Visual, Physical, and Walking Disabilities
Session Information
- Predictors of Clinical Outcomes After Kidney Transplantation
October 25, 2018 | Location: 6C, San Diego Convention Center
Abstract Time: 05:54 PM - 06:06 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Thomas, Alvin G., UNC Chapel HIll, Chapel Hill, North Carolina, United States
- Ruck, Jessica M., Johns Hopkins University, Baltimore, Maryland, United States
- Haugen, Christine E., Johns Hopkins University, Baltimore, Maryland, United States
- Shaffer, Ashton A., Johns Hopkins University, Baltimore, Maryland, United States
- Ying, Hao, Johns Hopkins University, Baltimore, Maryland, United States
- Garonzik wang, Jacqueline, Johns Hopkins University, Baltimore, Maryland, United States
- Norman, Silas, University of Michigan Health Systems, Ann Arbor, Michigan, United States
- Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
- McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
Background
Lower functional status is associated with higher mortality risk in kidney transplant (KT) recipients. Physical disabilities might also affect post-KT outcomes through similar pathways, but this population has not been well characterized.
Methods
Using a prospective 2-center cohort of 500 KT recipients 6/2013-12/2017, we compared normally able recipients to recipients with self-reported hearing, visual, physical, or walking disabilities. We used hybrid registry-augmented Cox regression to assess the association between disability status and post-KT outcomes (death-censored graft failure and mortality) by adjusting for recipient, donor, and transplant characteristics in the national population (SRTR N=76,112).
Results
Among the 500 KT recipients in our cohort, 24.2% reported a disability: 9.6% had a hearing disability, 16.2% had visual disability, 8.9% had a physical disability, and 11.7% had a walking disability. Compared to recipients that did not report a disability, recipients who reported a disability were more often Black (51.2% vs. 33.8%, p<0.001), spent longer on dialysis (median 2.7 vs. 1.9 years), less often college educated (62.1% vs. 74.6%, p<0.01), less often employed (31.9% vs. 49.7%, p<0.001), and more often on public insurance (67.8% vs. 53%, p<0.01). After adjustment, visual disability was associated with a 3.98-fold higher risk of graft failure and walking disability was associated with a 4.12-fold higher risk of mortality. Other self-reported disabilities were not associated with transplant outcomes (all p>0.05, Table 1).
Conclusion
In this two-center cohort, 24% of KT recipients reported a disability. Compared to recipients without a reported disability, recipients with a visual disability were at higher risk of graft failure and recipients with a walking disability were at higher risk of mortality. These KT recipients might benefit from additional supportive care and monitoring post-transplant.
Risk of Death-censored Graft Failure and Mortality
| Graft Failure aHR (95% CI) | p-value | Mortality aHR (95% CI) | p-value | |
| Any Disability | 1.58 (0.51-4.86) | 0.4 | 1.02 (0.39-2.70) | >0.9 |
| Visual Disability | 3.98 (1.38-11.50) | 0.01 | 1.02 (0.37-2.78) | >0.9 |
| Hearing Disability | 3.49 (0.95-12.85) | 0.06 | 0.68 (0.14-3.24) | 0.6 |
| Physical Disability | 0.72 (0.09-6.01) | 0.8 | 1.74 (0.55-5.51) | 0.4 |
| Walking Disability | 0.55 (0.07-4.32) | 0.6 | 4.12 (1.66-10.24) | 0.002 |
Funding
- NIDDK Support