Graft Function and Intermediate-Term Outcomes of Kidney Transplants Improved in the Last Decade: Analysis of the United States Kidney Transplant Database

Keith, Douglas S.; Vranic, Gayle; Nishio-Lucar, Angie G.

doi:10.1097/txd.0000000000000654

Cited by 19 publications

(13 citation statements)

References 50 publications

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“…The main driver of costs seemed to be a result of the increased use of specialized care units and increased costs associated with pneumonia and sepsis diagnosis. Advances in transplantation, such as the development of new immunosuppressive strategies and new surgical techniques, have improved the long-term survival rates of both the graft and the patient, while decreasing the rates of rejection [27,28]. However, even with these successful interventions, infections remain a major complication of transplantation and are large contributors to mortality rates in SOT recipients [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada – a retrospective cohort study

et al. 2019

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Infections continue to be a major cause of post-transplant morbidity and mortality, requiring increased health services utilization. Estimates on the magnitude of this impact are relatively unknown. Using national administrative databases, we compared mortality, acute care health services utilization, and costs in solid organ transplant (SOT) recipients to nontransplant patients using a retrospective cohort of hospitalizations in Canada (excluding Manitoba/Quebec) between April-2009 and March-2014, with a diagnosis of pneumonia, urinary tract infection (UTI), or sepsis. Costs were analyzed using multivariable linear regression. We examined 816 324 admissions in total: 408 352 pneumonia; 328 066 UTI's; and 128 275 sepsis. Unadjusted mean costs were greater in SOT compared to non-SOT patients with pneumonia []. Mortality (7.6% vs. 12.5%; P < 0.001), long-term care transfer (5.3% vs. 16.5%; P < 0.001), and mean length of stay (11.0 AE 17.7 days vs. 13.1 AE 24.9 days; P < 0.001) were lower in SOT. More SOT patients could be discharged home (63.2% vs. 44.3%; P < 0.001), but required more specialized care (23.5% vs. 16.1%; P < 0.001). Adjusting for age and comorbidities, hospitalization costs for SOT patients were 10% (95% CI: 8-12%) lower compared to non-SOT patients. Increased absolute hospitalization costs for these infections are tempered by lower adjusted costs and favorable clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada – a retrospective cohort study

et al. 2019

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“…Despite advances in immunosuppression and immune monitoring, long-term kidney allograft survival has not substantially improved in recent years [1][2][3]. Tenyear allograft failure for deceased donor transplant recipients was 52.8% in 2005 versus 59.2% in 1995 [3].…”

Section: Introductionmentioning

confidence: 99%

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

et al. 2018

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Background: Several studies have been performed to evaluate surrogate markers of long-term allograft function in renal transplant recipients. These include serum creatinine, estimated glomerular filtration rate (eGFR), slope of eGFR, and more recently eGFR variability. The aim of this study was to measure eGFR slope while assessing the variability of this slope and if high variability occurring at any time post-transplant was predictive of poorer long-term outcomes in a large cohort of kidney transplant recipients. Methods: Adult solitary kidney transplant recipients transplanted between July 1, 2005 and July 31, 2015 were included. The primary outcome was time to graft loss, defined as return to chronic dialysis, retransplant, or death. Secondary outcomes were death-censored graft loss and acute allograft rejection. Cox regression was utilized for primary and secondary outcomes. Multivariate logistic regression was used to determine baseline factors predictive of high eGFR variability. Results: A total of 1,543 patients were included in the analysis. The percentage of patients who experienced an eGFR coefficient of variation of <30% was 79.6% (1,229/1,543), while 20.4% (314/1,543) patients had high eGFR variability (≥30%). Patients with high eGFR variability tended to be younger, African-American and female. Those with higher eGFR variability, accounting for confounding and other eGFR measures (peak and slope), had significantly lower overall patient and graft survival. Conclusion: This study provides a novel analysis of the utility of eGFR variability in a large cohort. The clinical use of the slope of eGFR and eGFR variability may aid in predicting long-term graft outcomes and facilitate early patient discussions to change the trajectory of allograft function.

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“…Improvements in early graft outcomes have been consistently reported across multiple territories, with comparable 1‐year allograft survival rates between Europe and the USA, because of factors such as the reduction in hyperactive rejection resulting from improved immunological characterisation . Intermediate outcomes are also improving, even in the USA, with a reduction in graft failure over the first 3 years despite increasingly deleterious risk factors for graft failure, coincident with the pervasive use of Tacrolimus and Mycophenolate based regimes . However, Lamb et al .…”

Section: Discussionmentioning

confidence: 99%

“…Undoubtedly the improvements in long‐term outcomes in Ireland compared to jurisdictions such as the US could potentially represent a selection bias, with a more racially, genetically and immunologically heterogeneous donor and recipient profile elsewhere . However, the increased risk of adverse outcomes such as transplant rejection and graft loss known to associate with black race/ethnicity in the USA may not translate to other jurisdictions such as the United Kingdom, perhaps further evidence for the importance of nonbiological factors .…”

Section: Discussionmentioning

confidence: 99%

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Progressive improvement in short‐, medium‐ and long‐term graft survival in kidney transplantation patients in Ireland – a retrospective study

et al. 2019

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It is often quoted that while short-term graft survival in kidney transplantation has improved in recent years, it has not translated into a commensurate improvement in long-term graft survival. We considered whether this was true of the entire experience of the national kidney transplant program in Ireland. A retrospective analysis of the National Kidney Transplant Service (NKTS) database was undertaken to investigate patient and graft survival for all adult first deceased donor kidney transplant recipients in Ireland, 1971-2015. Three thousand two hundred and sixty recipients were included in this study. Kaplan-Meier methods were used to estimate survival at each time period post transplant for the various eras of transplantation. Uncensored graft survival has improved over the course of the program in Ireland at various time points despite risk factors for graft failure progressively increasing over successive eras. For example the graft survival at 15 years post transplant has increased from 10% in 1971-1975 to 45% by 1996-2000. Ireland has experienced a progressive improvement in long-term graft survival following kidney transplantation. Whether these trends are attributable to biological or nonbiological factors is unclear but likely involves a combination of both. Transplant International 2019; 32: 974-984

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Graft Function and Intermediate-Term Outcomes of Kidney Transplants Improved in the Last Decade: Analysis of the United States Kidney Transplant Database

Abstract: Supplemental digital content is available in the text.

Cited by 19 publications

References 50 publications

Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada – a retrospective cohort study

Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada – a retrospective cohort study

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

Progressive improvement in short‐, medium‐ and long‐term graft survival in kidney transplantation patients in Ireland – a retrospective study

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