Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant

Wolfe, Robert A.; Ashby, Valarie B.; Milford, Edgar L.; Ojo, Akinlolu; Ettenger, R; Agodoa, Lawrence Y.; Held, Philip J.; Port, Friedrich K.

doi:10.1056/nejm199912023412303

Cited by 4,658 publications

(3,048 citation statements)

References 23 publications

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“…The methods we have used are the same other investigators have used previously in assessing the relative survival of transplantation compared with remaining on the waiting list (13). The report of Wolfe et al (13) adjusted only for age, race, gender, transplant center, and cause of renal disease, and assumed that patients who were listed for transplant were otherwise equivalent. However, these assumptions may not be accurate in terms of selection of patients to receive a DHCV+ kidney.…”

Section: % CImentioning

confidence: 99%

The Impact of Transplantation with Deceased Donor Hepatitis C-Positive Kidneys on Survival in Wait-Listed Long-term Dialysis Patients

Abbott

Lentine

Bucci

et al. 2004

American Journal of Transplantation

130

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Whether transplantation of deceased donor kidney allografts from donors with antibodies against hepatitis C virus (HCV) confers a survival advantage compared with remaining on the kidney transplant waiting list is not yet known. We studied 38,270 USRDS Medicare beneficiaries awaiting kidney transplantation who presented with end-stage renal disease from April 1, 1995 to July 31, 2000. Cox regression was used to compare the adjusted hazard ratios for death among recipients of kidneys from deceased donors, and donors with antibodies against hepatitis C (DHCV+), controlling for demographics and comorbidities. In comparison to staying on the waiting list, transplantation from DHCV+ was associated with improved survival among all patients (adjusted hazard ratio for death 0.76, 95% CI 0.60, 0.96). Of patients receiving DHCV+ kidneys, 52% were themselves hepatitis C antibody positive (HCV+), so outcomes associated with use of these grafts may have particular implications for HCV+ transplant candidates. Recommendations for use of DHCV+ kidneys may require analysis of data not currently collected from either dialysis or transplant patients. However, transplantation of DHCV+ kidneys is associated with improved patient survival compared to remaining wait-listed and dialysis dependent.

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Section: % CImentioning

confidence: 99%

The Impact of Transplantation with Deceased Donor Hepatitis C-Positive Kidneys on Survival in Wait-Listed Long-term Dialysis Patients

Abbott

Lentine

Bucci

et al. 2004

American Journal of Transplantation

130

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“…Kidney transplant is the best treatment option for patients with end‐stage renal disease 1. The discovery and development of potent immunosuppressive drugs that are able to prevent or treat rejection have greatly improved short‐term graft survival rates over the past 50 years 2.…”

Section: Introductionmentioning

confidence: 99%

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Kamburova

Wisse

Joosten

et al. 2018

American Journal of Transplantation

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The presence of donor‐specific anti‐HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long‐term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement‐dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10‐year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10‐year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10‐year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.

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“…Kidney transplantation (KT) reduces cardiovascular risk in patients with end‐stage renal disease, with cardiovascular death rates reduced by ≈75% in transplant recipients when compared with matched patients undergoing dialysis still on the waiting list 13, 14. This important benefit is mainly explained by the reversal of renal dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Reversal of Arterial Stiffness and Maladaptative Arterial Remodeling After Kidney Transplantation

Karras

Boutouyrie

Briet

et al. 2017

JAHA

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BackgroundChronic kidney disease is characterized by stiffening, thinning, dilatation, and increased circumferential wall stress of large arteries, associated with increased cardiovascular risk. Kidney transplantation (KT) reverses many pathological features of chronic kidney disease and improves life expectancy; however, longitudinal studies exploring the impact of KT on recipient large arteries are scarce.Methods and ResultsThis study was designed to appraise arterial changes following KT. Carotid‐femoral pulse wave velocity, carotid remodeling (circumferential wall stress and carotid internal diameter), and stiffness were measured in 161 consecutive recipients receiving either a living (n=49) or a deceased (n=112) donor allograft, at 3 and 12 months after transplantation. Mean pulse wave velocity decreased from 10.8 m/s (95% confidence interval, 10.5–11.2 m/s) (at month 3) to 10.1 m/s (95% confidence interval, 9.8–10.5 m/s) (at month 12) (P<0.001). After multivariate adjustment, pulse wave velocity reduction from month 3 to month 12 was significantly larger in the living donor allograft KT (P<0.001). Circumferential wall stress decreased, 70 kPa (95% confidence interval, 68–72 kPa) to 64 kPa (95% confidence interval, 62–67 kPa), as well as carotid internal diameter and carotid stiffness (P<0.001 for all). Reductions in circumferential wall stress, diameter, and stiffness were significantly larger in the living donor allograft KT (P<0.001). When deceased donor allograft patients were classified into standard and expanded criteria donors, changes in both pulse wave velocity and circumferential wall stress were blunted in expanded criteria donors. Changes were independent of graft function and blood pressure changes.ConclusionsLarge‐artery stiffness and maladaptive carotid artery remodeling of chronic kidney disease is partially reversed within 12 months of KT and appears unrelated to renal function. Improvements were independently associated with live organ donation. Our data suggest that expanded criteria donors may hamper vascular recovery.

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Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant

Abstract: Among patients with end-stage renal disease, healthier patients are placed on the waiting list for transplantation, and long-term survival is better among those on the waiting list who eventually undergo transplantation.

Cited by 4,658 publications

References 23 publications

The Impact of Transplantation with Deceased Donor Hepatitis C-Positive Kidneys on Survival in Wait-Listed Long-term Dialysis Patients

The Impact of Transplantation with Deceased Donor Hepatitis C-Positive Kidneys on Survival in Wait-Listed Long-term Dialysis Patients

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Reversal of Arterial Stiffness and Maladaptative Arterial Remodeling After Kidney Transplantation

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