Factors affecting mortality during the waiting time for kidney transplantation: A nationwide population-based cohort study using the Korean Network for Organ Sharing (KONOS) database.

Sunhwa Lee,Yon Su Kim,Kyung Don Yoo,Chun Soo Lim,Yun Kyu Oh,Jung Pyo Lee,Jung Nam An,Ping-Hsun Wu

doi:10.1371/journal.pone.0212748

Abstract

BackgroundLong waiting time for deceased donor kidney transplant is inevitable due to the scarcity of donor, resulting in highlighting the importance of waiting time care. We analyzed the Korean Network for Organ Sharing (KONOS) database to assess the impact of waiting time on post-transplant survival outcomes and investigate risk factors for mortality by waiting time based on a complete enumeration survey in Korea.MethodsWe analyzed all persons aged over 18 years in deceased donor kidney transplant cases enrolled in the Korean Network for Organ Sharing (KONOS) database from January 2000 to January 2015. The primary end point was all-cause mortality after enrollment.ResultsOf the 24,296 wait-listed subjects on dialysis, 5,255 patients received kidney transplants from deceased donors, with a median waiting time of 4.5 years. Longer waiting times had distinct deleterious effects on overall survival after transplantation. While waiting for a transplant, patients with diabetes were more likely to die before transplantation (HR 1.515, 95% CI 1.388–1.653, p<0.001). Age was another significant risk factor for mortality. Only 56% of people aged 65 years survived after 10 years of waiting, whereas 86% of people aged 35 years survived after 10 years. Moreover, women on the waiting list were more likely to live longer than men on the list.ConclusionsMore attention should be focused on patients with a higher risk of mortality while waiting for a deceased donor kidney transplant, such as patients with diabetes, those of advanced age, and those who are male.

Highlights

The number of patients with end-stage renal disease (ESRD) is increasing rapidly at a rate of 5–7% per year [1]
While waiting for a transplant, patients with diabetes were more likely to die before transplantation (HR 1.515, 95% confidence interval (CI) 1.388–1.653, p
More attention should be focused on patients with a higher risk of mortality while waiting for a deceased donor kidney transplant, such as patients with diabetes, those of advanced age, and those who are male

Summary

Introduction

The number of patients with end-stage renal disease (ESRD) is increasing rapidly at a rate of 5–7% per year [1]. In South Korea, the total number of patients receiving renal replacement therapy (RRT) has increased from 746 to 1,464 patients per million population during the past 10 years (from 2006 to 2016), whereas kidney transplantation cases have increased from 550 to 1,112 patients per million population. As of December 2017, 19,807 patients were on the Korean Network for Organ Sharing (KONOS) waiting list for kidney transplantation. During the last decade in Korea, a 22.4% annual increase in the kidney transplantation waiting list was recorded. The waiting time for kidney transplantation is an issue of growing importance. We analyzed the Korean Network for Organ Sharing (KONOS) database to assess the impact of waiting time on post-transplant survival outcomes and investigate risk factors for mortality by waiting time based on a complete enumeration survey in Korea

Methods

Results

Conclusion