Abstract: TH-PO1007
Effect of Native Kidney Disease Etiology on Graft and Patient Outcomes After Kidney Transplantation
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Strazny, Mia Josephine, UW Health, Madison, Wisconsin, United States
- Ylagan, Camille, UW Health, Madison, Wisconsin, United States
- Mandelbrot, Didier A., UW Health, Madison, Wisconsin, United States
- Garg, Neetika, UW Health, Madison, Wisconsin, United States
- Thiessen, Carrie, UW Health, Madison, Wisconsin, United States
- Astor, Brad C., UW Health, Madison, Wisconsin, United States
- Parajuli, Sandesh, UW Health, Madison, Wisconsin, United States
Background
Kidney transplant recipients (KTRs) experience different long-term graft and patient outcomes. We hypothesize that native ESKD etiology influences the risk profiles associated with death-censored graft failure (DCGF) and death with functioning graft (DWFG).
Methods
Adult KTRs transplanted between 2001 and 2021 at our center were stratified into 5 groups based on native ESKD etiology: diabetes mellitus (DM), hypertension (HTN), polycystic kidney disease (PKD), glomerulonephritis (GN), and other. For each, we analyzed risk factors for DCGF and DWFG.
Results
A total of 5,659 KTRs were included (DM: 1468, HTN: 676, GN: 1440, PKD: 750, other: 1325).
Older donor age was associated with increased risk of DCGF across all etiologies when adjusted (DM: aHR 1.23, 95% CI 1.13-1.35; HTN: aHR 1.18, 95% CI 1.04-1.33; GN: aHR 1.29, 95% CI 1.11-1.49; PKD: aHR 1.2, 95% CI 1.09-1.31; other: aHR 1.14, 95% CI 1.04-1.26). Prolonged pretransplant dialysis was associated with increased DCGF risk across all etiologies except HTN. Additional risks among recipients with DM included older recipient age, higher HLA mismatch, and longer cold ischemia time. Higher recipient BMI was associated with increased risk in GN and PKD. Previous transplant was an additional risk factor in recipients with GN. HTN had no other significant predictors.
For DWFG, older recipient age was associated with increased risk for all groups (DM: aHR 1.48, 95% CI 1.31-1.68; HTN: aHR 1.87, 95% CI 1.55-2.26; PKD: aHR 2.26, 95% CI 1.74-2.94; GN: aHR 1.88, 95% CI 1.64-2.16; other: aHR 1.76, 95% CI 1.58-1.96). GN had the greatest number of predictors, including hemodialysis duration, higher HLA mismatch, prior transplant, and longer cold ischemia time. Donor-related factors were not associated with DWFG. Kaplan-Meier curves demonstrated significant variation in DCGF and DWFG by ESKD etiology (Figure 1).
Conclusion
In this large cohort of kidney transplant recipients, we identified risk factors for detrimental post-transplant outcomes based ESKD etiology. Focusing on specific risk factors may mitigate some poor outcomes.
Figure 1. Kaplan-Meier analysis of KTRs with (A) DCGF, and (B) DWFG by ESRD etiology.