Kidney Week

Abstract: TH-PO1019

Survival After Kidney Transplantation vs. Dialysis in Wait-Listed Patients with Diabetic Kidney Disease: A Target Trial Emulation Study

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

• Bagchi, Soumita, All India Institute of Medical Sciences New Delhi, New Delhi, DL, India

Soumita Bagchi, MD

• Wang, Jiayue, Children's Hospital at Westmead Centre for Kidney Research, Westmead, New South Wales, Australia

Jiayue Wang, MSc

• Zhu, Lin, University of Technology Sydney, Sydney, New South Wales, Australia

Lin Zhu, PhD, MPH

• Teixeira-Pinto, Armando, Children's Hospital at Westmead Centre for Kidney Research, Westmead, New South Wales, Australia

Armando Teixeira-Pinto, PhD

• Lim, Wai Hon, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia

Wai Hon Lim, MD, PhD

• Wong, Germaine, Children's Hospital at Westmead Centre for Kidney Research, Westmead, New South Wales, Australia

Germaine Wong, MBBS, PhD

Background

Observational studies suggest poorer survival in patients diabetic kidney disease (DKD) associated kidney failure compared to other causes of kidney disease. This may be attributed to inadequate handling of immortal time or time-to-treatment biases. We emulated a target trial to estimate the causal effect of deceased donor kidney transplantation (DDKT) versus dialysis on mortality in DKD patients with kidney failure, compared to those with kidney failure due to IgA nephropathy (IgAN), and other glomerular diseases (GD).

Methods

We analyzed data from the Australia and New Zealand Dialysis and Transplant Registry including adults waitlisted for DDKT in Australia (2010–2023). Using a target trial emulation framework with clone–censor–weight method, patients were cloned at waitlisting and assigned to transplantation within 3 years or continued dialysis. Monthly censoring accounted for deviations, and inverse probability weights addressed informative censoring. The primary outcome was all-cause mortality.

Results

5,155 patients (DKD n=2,382; IgAN n=1,039; other GD n=1,734), with median follow-up of 60 months were analyzed.
Transplantation demonstrated a clear time-dependent survival benefit across all groups. In DKD, transplantation reduced mortality by 13.94% (95% CI: 8.87–18.76) with an RMST gain of 2.23 months (95% CI: 1.53–2.94) at 60 months, increasing to 47.28% (95% CI: 37.07–56.72) and 17.29 months (95% CI: 13.88–20.59) at 108 months.
In IgAN, early post-transplant mortality was slightly higher at 12–24 months, however, there was 38.30% (95% CI: 6.24–61.70) reduction in mortality and a 6.49 months survival gain (95% CI: 0.48–11.85) at 108 months. Other GD patients also had modest benefit at 60 months with 40.63% (95% CI: 17.82–64.02) reduction in mortality and a survival gain of 9.20 months (95% CI: 3.93–14.62) at 108 months.
Subgroup analyses showed consistent long-term benefits across age and sex in DKD patients, although early benefit was more evident in patients <60 years. Sensitivity analyses using shorter grace periods (1 and 2 years) yielded similar results.

Conclusion

DDKT is associated with substantial long-term survival benefit compared with dialysis across major kidney disease subtypes with the greatest absolute gains in DKD patients.