Abstract P062: The Benefits of Preemptive Transplant Vary by Cause of End-stage Renal Disease

Abstract

Introduction: Cardiovascular events, i.e. cardiac arrest and arrhythmia, are the leading cause of death among patients with end-stage renal disease (ESRD). Kidney transplantation (KT) reduces mortality and is the preferred treatment for ESRD. Generally, preemptive KT, especially with a living donor, reduces mortality over KT after dialysis initiation. Mortality reduction by preemptive KT may vary by cause of ESRD. Hypothesis: Decreased all-cause mortality after preemptive KT varies by cause of ESRD. Methods: We studied 56,927 adult living donor KT recipients from 2000 to 2017 using the Scientific Registry of Transplant Recipients. We compared all-cause mortality in preemptive living donor KT recipients to those who underwent living donor KT within a year of starting dialysis, stratifying by cause of ESRD. We estimated the adjusted hazard ratio (aHR) of mortality comparing KT with <1 year on dialysis to preemptive KT recipients accounting for recipient and transplant factors using inverse probability weights. Results: Compared to recipients on <1 year of dialysis, preemptive KT recipients were more often female, older, college educated, employed, and had higher BMI (all p<0.001). The association between preemptive KT and post-KT mortality did vary by cause of ESRD (Figure 1). For example, among recipients with ESRD caused by type I diabetes, <1 year on dialysis was associated with a higher hazard of mortality (aHR: 1.32 (1.17-1.50), p<0.001). However, among recipients with ESRD caused by hypertension (p=0.1) or type II diabetes (p=0.3), there was not a statistically significantly difference in mortality comparing KT with <1 year on dialysis vs. preemptive KT. Conclusions: Our findings suggest that for particular ESRD patients, like those with type I diabetes, early counseling regarding preemptive KT and finding a living donor are imperative. Future studies should assess whether expedited review of potential living donors for these patients reduces mortality in this population at high risk of cardiovascular events.