TY - JOUR
T1 - Patient and kidney allograft survival with national kidney paired donation
AU - Leeser, David B.
AU - Thomas, Alvin G.
AU - Shaffer, Ashton A.
AU - Veale, Jeffrey L.
AU - Massie, Allan B.
AU - Cooper, Matthew
AU - Kapur, Sandip
AU - Turgeon, Nicole
AU - Segev, Dorry L.
AU - Waterman, Amy D.
AU - Flechner, Stuart M.
N1 - Funding Information:
Dr. Leeser participated in research design, writing, and data analysis. Mr. Thomas participated in research design, writing, and data analysis. Dr. Shaffer participated in research design and data analysis. Dr. Veale participated in research design and writing. Dr. Massie participated in research design and data analysis. Dr. Cooper participated in research design and writing. Dr. Kapur participated in research design and writing. Dr. Turgeon participated in research design and writing. Dr. Segev participated in research design, writing, and data analysis. Dr. Waterman participated in research design, writing, and data analysis. Dr. Flechner participated in research design, writing, and data analysis. The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR, Organ Procurement and Transplantation Network, or the US Government. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.. Dr. Leeser is a member of the National Kidney Registry Medical Board. Dr. Massie is supported by National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant K01DK101677. Dr. Segev is supported by NIDDK grant K24DK101828. Dr. Shaffer is supported by NIDDK grant F30DK116658. Mr. Thomas is supported by National Heart, Lung, and Blood Institute grant T32HL007055.
Funding Information:
Dr. Leeser is a member of the National Kidney Registry Medical Board. Dr. Massie is supported by National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant K01DK101677. Dr. Segev is supported by NIDDK grant K24DK101828. Dr. Shaffer is supported by NIDDK grant F30DK116658. Mr. Thomas is supported by National Heart, Lung, and Blood Institute grant T32HL007055.
Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/2/7
Y1 - 2020/2/7
N2 - Background and objectives In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described. Design, setting, participants, & measurements Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m2, diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m2), and transplant factors (zero HLA mismatch). Results National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1–5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients. Conclusions Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.
AB - Background and objectives In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described. Design, setting, participants, & measurements Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m2, diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m2), and transplant factors (zero HLA mismatch). Results National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1–5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients. Conclusions Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.
UR - http://www.scopus.com/inward/record.url?scp=85079154253&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85079154253&partnerID=8YFLogxK
U2 - 10.2215/CJN.06660619
DO - 10.2215/CJN.06660619
M3 - Article
C2 - 31992572
AN - SCOPUS:85079154253
SN - 1555-9041
VL - 15
SP - 228
EP - 237
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -