Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort.

Rachel Hellemans,Kim Luyckx,Steven Van Laecke,Alain Le Moine,Ineke Tieken,Karl Martin Wissing,Anneke Kramer,Michel Jadoul,Kitty J Jager,Undine Samuel,Vianda S Stel,Daniel Abramowicz,Jean-Marie Krzesinski,Dirk Kuypers,Serge Vogelaar,Marieke Van Meel,Johan De Meester,Erwin De Vries,Frederic Collart

doi:10.1093/ndt/gfab024

Abstract

BackgroundChanges in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis.MethodsWe analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. The primary outcome was mortality during the median waiting time plus 3 years of follow-up after transplantation or with continued dialysis. Outcomes were analysed separately for standard criteria donor (SCD) and expanded criteria donor (ECD) kidney transplants. We adjusted survival analyses for recipient age (20–44, 45–64 and ≥65 years), sex and diabetes as the primary renal disease.ResultsAmong patients ≥65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2–19.9] with SCD transplantation, 20.5% (95% CI 16.1–24.6) with ECD transplantation and 24.6% (95% CI 19.4–29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups.ConclusionsThe results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small.

Highlights

Since 1999, when Wolfe et al [1] reported a survival benefit for US patients receiving a first deceased donor kidney transplantation as compared with waitlisted dialysis patients, kidney transplantation has been assumed to offer better survival
The results of this study suggest that older patients might gain a survival benefit with standard criteria donor (SCD) transplantation versus dialysis, but any survival benefit with expanded criteria donor (ECD) transplantation versus dialysis may be small
Our findings suggest that even patients >65 years of age experience a survival benefit with transplantation, at least when transplanted with an SCD kidney

Summary

Introduction

Since 1999, when Wolfe et al [1] reported a survival benefit for US patients receiving a first deceased donor kidney transplantation as compared with waitlisted dialysis patients, kidney transplantation has been assumed to offer better survival. We analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. Among patients 65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2–19.9] with SCD transplantation, 20.5% (95% CI 16.1–24.6) with ECD transplantation and 24.6% (95% CI 19.4–29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups. The results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small

Methods

Results

Conclusion