Abstract: FR-PO1206
Improvement in Long-Term Graft Survival of Post-1-Year Survivor Kidney Transplant Recipients in the United States
Session Information
- Transplantation: Clinical - Immunosuppression, Adherence, Outcomes
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Wu, Catherine, Baylor College of Medicine, Houston, Texas, United States
- Rana, Abbas, Baylor College of Medicine, Houston, Texas, United States
- Goss, John A., Baylor College of Medicine, Houston, Texas, United States
- Anumudu, Samaya Javed, Baylor College of Medicine, Houston, Texas, United States
- Murthy, Bhamidipati V.R., Baylor College of Medicine, Houston, Texas, United States
Background
Advances in prevention and treatment of acute rejection of kidney transplants significantly improved the short-term allograft survival. However, these successes have not been translated to long term outcomes of kidney transplants. We re-evaluated long-term graft survival for recipients whose survived one year after kidney transplantation such that the short-term adverse outcomes do not cloud the long term outcomes.
Methods
We retrospectively analyzed 219,645 recipients from 1995 to 2017 using data from the United Network for Organ Sharing. Patients undergoing re-transplants, multiorgan transplants, and recipients <18 years age at transplantation were excluded. Patients who died within 1 year of transplantation were excluded. Multivariable Cox regression was employed to estimate graft survival.
Results
Compared with patients transplanted during the period 1996-2000, on multivariate analysis, the hazard ratio (HR) for graft loss for 2001-2005 was 0.88, 2006-2010 was 0.73, and 2011-2016 was 0.63. The HR for graft loss for males was 1.12, age >60 years (vs 18-40) was 1.39, Blacks (vs Whites) was 1.34, BMI >30 (vs 18.6-25) was 1.13, dialysis prior to transplant (vs pre-emptive) was 1.40, diabetes was 1.52, and deceased donor (vs living donor) was 1.38. Compared to patients with PRA 0-79%, the HR for graft loss for PRA 80-89% was 1.15, and for 90-100% was 1.22. Compared to donor age 18-29 years, HR with donors 30-39 yrs was 1.10, 40-50 years was 1.26, and >50 years was 1.50. All these were statistically signicant with p<0.0001.
Conclusion
Long-term graft survival among kidney transplant recipients in the US has improved steadily over time. While advances in maintenance immunosuppression, and prevention and treatment of antibody-mediated rejection may have contributed, further research is needed to better understand other causes behind this improvement in kidney graft survival over the past 30 years.