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Abstract: SA-OR099

Greater Impact of Pre-Transplant Dialysis Exposure on Transplant Survival in Regions with Higher Dialysis Mortality

Session Information

Category: Transplantation

  • 1901 Transplantation: Basic

Authors

  • Gill, John S., (St. Paul's Hospital/University of British Columbia), Vancouver, British Columbia, Canada
  • Clark, Stephanie, Providence Health Care - St. Paul`s Hospital, Vancouver BC, British Columbia, Canada
Background

Longer pre-transplant dialysis exposure is associated with a higher risk of transplant failure. Mortality rates on dialysis are known to vary between regions, and may in part reflect differences in the quality of dialysis care. We hypothesized that the association of dialysis exposure with transplant failure would be higher in patients treated in regions with higher rates of dialysis mortality.

Methods

Adult patients in the United States Renal Data System who initiated maintenance hemodialysis after May 1995, and received a kidney-only deceased donor transplant by Dec 2010 were studied (n=63,610). Dialysis mortality (per 100 patient years), adjusted for differences in patient age, sex, and race, was determined by state of residence and time period of dialysis, and grouped into quartiles. The association between the duration of dialysis exposure (years), dialysis mortality quartile and post transplant outcomes was determined in Cox regression models. Each model adjusted for differences in patient age, gender, race, cause of end stage kidney disease, body mass index, year of transplant, PRA, comorbid conditions and included an interaction term of dialysis exposure (years) with quartile of dialysis mortality.

Results

The association of different combinations of dialysis exposure (years) and dialysis mortality (quartiles), compared to the reference group of patients with <1 year dialysis exposure treated in a region with the lowest quartile of dialysis mortality, with the outcomes of graft loss from all causes including death, death censored graft loss, and death with a functioning graft are shown in Figure 1. Longer durations of dialysis exposure were associated with a higher risk of each outcome, and this risk of dialysis exposure was magnified in regions with higher dialysis mortality.

Conclusion

The risk of pre-transplant dialysis exposure on transplant failure is higher in regions with higher rates of dialysis mortality. The findings support better integration of dialysis and transplant care, and indicate that regional differences in dialysis mortality should be accounted for in evaluation of transplant center performance metrics.