Outcomes of end-stage renal disease patients on the waiting list for deceased donor kidney transplantation: A single-center study

Abstract

Background Kidney transplantation is an effective renal replacement therapy for patients with end-stage renal disease (ESRD). In this study, we assessed the impact of the baseline characteristics and comorbidities of ESRD patients on the probability of deceased donor kidney transplantation (DDKT) and evaluated the morbidity and mortality during the time spent waiting. Methods The study population consisted of 544 ESRD patients on the waiting list for DDKT at Chungnam National University Hospital in South Korea between February 2000 and October 2015. The patients were observed from the date of transplantation list registration to the date of transplantation. Baseline characteristics and comorbidities were investigated together with new-onset comorbidities that occurred during the waiting time. Results Diabetes mellitus (39.0%), hypertension (25.2%), and glomerulonephritis (21.3%) were the three most common causes of ESRD in this study, and coronary artery disease (9.4%) was the most common comorbidity. The 115 patients (19.3%) who underwent DDKT had a mean waiting time of 1,711 days (768–2,654 days or 4.68 years [2.10–7.27]). Blood groups other than type O, peritoneal dialysis, and nondiabetic ESRD were significantly associated with a higher likelihood of DDKT. Infection was the leading cause of death and the most common comorbidity that arose during the waiting time. Patients who experienced cardiovascular events during the waiting time showed a lower transplant rate compared with those who did not. Conclusion The prevalence of comorbidities was high in renal transplantation candidates. During the often-long waiting time, new comorbidities may occur, with long-term sequelae limiting access to kidney transplantation or resulting in death.

Excellent outcome after desensitization in high immunologic risk kidney transplantation

“…Kidney transplantation (KT) is the treatment of choice for the most end-stage renal disease (ESRD) patients [1, 2]. However, donated kidneys are still scarce, and many ESRD patients around the world are waiting for transplants [3]. To address this issue, HLA-incompatible (HLAi) and ABO-incompatible (ABOi) KT were introduced, and the use of these techniques has been on the increase over the last decade.…”

Impact of type 2 diabetes mellitus on kidney transplant rates and clinical outcomes among waitlisted candidates in a single center European experience

“…Similar to Lee et al 8 T2D patients experienced a higher mortality during WL also in our study and, as expected, cardiovascular events (probably underestimated due to the absence of a determined death cause in the majority of patients) were the most common cause of death in this group. Cardiovascular disease are typical comorbidities affecting all ESKD patients, with higher prevalence and incidence than in general population: they can aggravate the underlying medical condition and limit the access to KT 7 . Successful KT accords major benefits by reducing cardiovascular risk in these patients, and efforts are needed to minimize WL time 32 .…”

“…Based on our study design, not influenced by a negative-selection bias, we speculate that the reduced likelihood of KT among T2D group may also suggest a per-se negative effect of T2D on KT rate. In one recent study by Jeon et al the occurrence of cardiovascular disease but not diabetes determined lower transplant rates 7 , so it could be important to investigate the possible negative T2D effect in larger cohorts.…”

“…KT is considered the gold standard for ESKD for its superiority to dialysis for all outcomes (quality of life, overall survival, economic costs) 5 , 6 and, despite some authors suggested negative or “not-so-positive” results in T2D patients 7 , recent reports outline favorable outcome also in T2D patients 8 . On the other hand few studies are focused on T2D patients who could be considered eligible for KT, and none of them at the best of our knowledge have evaluated if WL time—a variable directly correlated to negative outcome both for patient and KT 7 , 8 —could be influenced by the intrinsic T2D frailty for T2D-related comorbidities.…”

Cancer Development and Mortality Differences in Patients with Glomerulonephritis after Renal Biopsy: A Single Center Retrospective Cohort Study

“…Glomerulonephritis (GN) is a heterogeneous set of diseases caused by immune or inflammatory pathogenesis in the glomerular lesion. Although the incidence of GN is decreasing worldwide, it remains the third leading cause of end-stage renal disease (ESRD) in most countries, including South Korea [1][2][3]. The incidence of GN exhibits two peaks for age at the age of 20-30 years and ≥ 60 years [4].…”