Functional Status, Time to Transplantation, and Survival Benefit of Kidney Transplantation Among Wait-Listed Candidates

Abstract

Background In the context of an aging end-stage renal disease population with multiple comorbidities, transplantation professionals face challenges in evaluating the global health of patients awaiting kidney transplantation. Functional status might be useful for identifying which patients will derive a survival benefit from transplantation versus dialysis. Study Design Retrospective cohort study of wait-listed patients using data on functional status from a national dialysis provider linked to United Network for Organ Sharing registry data. Setting & Participants Adult kidney transplant candidates added to the waiting list between the years 2000 and 2006. Predictor Physical function scale of the Medical Outcomes Study 36-Item Short Form Healthy Survey, analyzed as a time-varying covariate. Outcomes Kidney transplantation; Survival benefit of transplantation versus remaining wait-listed. Measurements We used multivariable Cox regression to assess the association between physical function with study outcomes. In survival benefit analyses, transplant status was modeled as a time-varying covariate. Results The cohort comprised 19,242 kidney transplant candidates (median age, 51 years; 36% black race) receiving maintenance dialysis. Candidates in the lowest baseline physical function quartile were more likely to be inactivated (adjusted HR vs. highest quartile, 1.30; 95% CI, 1.21-1.39) and less likely to undergo transplantation (adjusted HR vs. highest quartile, 0.64; 95% CI, 0.61-0.68). After transplantation, worse physical function was associated with shorter 3-year survival (84% vs. 92% for the lowest vs. highest function quartiles). However, compared to dialysis, transplantation was associated with a statistically significant survival benefit by 9 months for patients in every function quartile. Limitations Functional status is self-reported. Conclusions Even patients with low function appear to live longer with kidney transplantation versus dialysis. For waitlisted patients, global health measures like functional status may be more useful in counseling patients about the probability of transplantation than in identifying who will derive a survival benefit from it.

Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk?

“…In addition, the risk of death in older KT recipients increases with increased comorbidity during the first post-transplant year [39, 45]. Finally, older KT recipients are susceptible to cognitive impairment, poor functional status and frailty, increasing hospital readmission and mortality risk [46-50]. However, death-censored graft survival in the elderly, including KT recipients 80 years and older, appears to be comparable to or even better than that in younger KT recipients in the long term [40, 51, 52].…”

Older candidates for kidney transplantation: Who to refer and what to expect?

“…Functional status measurements are subjective and are obtained via questionnaires such as the short form-36 (SF-36) Physical Function (PF) scale, Vulnerable Elderly Survey-13, or Physical Activity Scale for the Elderly. A number of studies have reported an association between functional status and patient survival[15-19]. In the largest study to date, Reese et al[19] analyzed 19242 Fresenius dialysis patients who had answered the SF-36 PF scale pre-transplant and had linked post-transplant data via the UNOS registry.…”

“…A number of studies have reported an association between functional status and patient survival[15-19]. In the largest study to date, Reese et al[19] analyzed 19242 Fresenius dialysis patients who had answered the SF-36 PF scale pre-transplant and had linked post-transplant data via the UNOS registry. Patient PF scores were divided into PF quartiles and these were correlated with time to kidney transplantation and the net survival benefit of kidney transplantation vs remaining on the waiting list.…”

A Molecular Signature of Two Long Non-Coding RNAs in Peripheral Blood Predicts Acute Renal Allograft Rejection

“…Renal transplantation is the preferred treatment of choice for patients with end stage renal disease (ESRD) [1, 2]. Despite substantial improvements in immunosuppressive therapies and surgical techniques, acute rejection (AR) remains a frequent and serious post-transplantation complication, which contributes to late allograft loss and mortality [3, 4].…”