1025 SLEEP APNEA AND KIDNEY TRANSPLANT GRAFT SURVIVAL: FINDINGS FROM AN 18-YEAR (1997–2015) HISTORICAL COHORT STUDY

Abstract

Sleep apnea has been linked to the acceleration of renal failure in end-stage renal disease (ESRD). However, few studies have examined the association of sleep apnea to kidney functioning in ESRD patients post-transplant. A historic cohort study of kidney transplant recipients with a failed graft from a single-center examined the association between sleep apnea and kidney transplant graft survival time. Adult patients who were transplanted and failed or died with a functioning graft during the designated study time period (January 1, 1997-September 1, 2015) were included (n=299). Sleep apnea was defined as a diagnosis in a patient’s medical record documented prior to graft failure. Graft survival time was defined as graft failure and/or cardiovascular death with a functioning graft, two common outcomes of kidney transplantation associated with ESRD. Non-cardiovascular related deaths with a functioning graft were censored. A Cox regression, stratified by year of transplant surgery, modeled the association of diagnosed sleep apnea with graft survival time. Using backward elimination, models were adjusted for age, gender, functional status, and antigen mismatch. Sleep apnea prevalence in this cohort was 17%. Due to a significant (p ≤0.01, adjusted model) sleep apnea by transplant year heterogeneity for graft survival time, Cox regression models were stratified. For patients transplanted between 1997–2008, sleep apnea was associated with a decreased (albeit non-significantly) risk of graft failure and/or cardiovascular death (adjusted Hazard Ratio (HR) = 0.67, 95% CI, 0.45–1.01). For patients transplanted between 2009–2015, sleep apnea statistically significantly increased graft failure and/or cardiovascular death risk (adjusted HR = 2.94, 95% CI, 1.12–7.75). In a single-center cohort of kidney transplant recipients with a failed graft, sleep apnea increased the risk of graft failure and/or cardiovascular death with a functioning graft nearly three-fold among patients transplanted between 2009–2015. Further research is needed to better understand this relationship and whether prevention strategies, including treating sleep apnea, might increase longevity in kidney transplant patients. Data abstraction continuing through January 1, 2017 will allow evaluation of a twenty-year follow-up of this historical cohort study. None