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Kidney Week

Abstract: FR-PO1205

Trends in Causes of Death in Australian and New Zealand Kidney Transplant Recipients: A Registry Analysis by Era and Time Post Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Ying, Tracey, Royal prince Alfred hospital, Camperdown, New South Wales, Australia
  • Shi, Bree, University of Sydney, Camperdown, New South Wales, Australia
  • Kelly, Patrick, The University of Sydney, Camperdown, New South Wales, Australia
  • Clayton, Philip A., Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • Chadban, Steven J., Royal prince Alfred hospital, Camperdown, New South Wales, Australia
Background

Donor and recipient characteristics in kidney transplantation (KT) have changed dramatically since the 1980s. Along with an increase in marginal donors and older recipients, incremental improvements have ensued in immunosuppression, surgical techniques and cardiovascular (CV) disease management. A contemporary assessment of the risks and determinants of deaths in KT recipients is required to better inform our patients.

Methods

Using the ANZDATA registry, we included all kidney-only transplant recipients between 1980 to 2017. We censored patients at graft loss or date of last follow-up. We calculated crude death rates by dividing the number of deaths by the total patient-years at risk. Adjusted death rates per 5-year intervals were compared using a piecewise exponential model, stratified by time period post-transplant.

Results

22,078 incident KT recipients accumulated 183,964 person-years of follow-up. The adjusted all-cause death rate was 2% per annum, remaining stable since 2005. Compared with 1995-1999, KT recipients in 2015-2017 were older (mean age 47 vs. 41) and had more comorbidities (CVD 25% vs. 13%, diabetes 24% vs. 10%). Since 1980, there has been a significant reduction in CV and infection-related deaths at all periods post-transplant (Figure-1). Recipients in the current era had a 56% reduction in CV deaths (adjusted HR=0.44, 95%CI 0.36-0.52) and 53% reduction in infection-related deaths (adjusted HR=0.47, 95%CI 0.36-0.61), compared with recipients in 2000-2004. Short-term cancer-deaths have remained stable over time, with a marginal fall in long-term cancer-deaths since 2005.

Conclusion

The risk of death after KT has reduced significantly since the 1980s, driven by a reduction in CV death at all time points and a decline in infection-related deaths. Contrary to previous studies, cancer-deaths have remained stable over time after adjusting for time post-transplant.