Abstract
Comorbidity is increasingly common in kidney transplant recipients, yet the implications for transplant outcomes are not fully understood. We analyzed the relationship between recipient comorbidity and survival outcomes in a UK-wide prospective cohort study-Access to Transplantation and Transplant Outcome Measures (ATTOM). A total of 2100 adult kidney transplant recipients were recruited from all 23 UK transplant centers between 2011 and 2013. Data on 15 comorbidities were collected at the time of transplantation. Multivariable Cox regression models were used to analyze the relationship between comorbidity and 2-year graft survival, patient survival, and transplant survival (earliest of graft failure or patient death) for deceased-donor kidney transplant (DDKT) recipients (n = 1288) and living-donor kidney transplant (LDKT) recipients (n = 812). For DDKT recipients, peripheral vascular disease (hazard ratio [HR] 3.04, 95% confidence interval [CI]: 1.37-6.74; P = 0.006) and obesity (HR 2.27, 95% CI: 1.27-4.06; P = 0.006) were independent risk factors for graft loss, while heart failure (HR 3.77, 95% CI: 1.79-7.95; P = 0.0005), cerebrovascular disease (HR 3.45, 95% CI: 1.72-6.92; P = 0.0005), and chronic liver disease (HR 4.36, 95% CI: 1.29-14.71; P = 0.018) were associated with an increased risk of mortality. For LDKT recipients, heart failure (HR 3.83, 95% CI: 1.15-12.81; P = 0.029) and diabetes (HR 2.23, 95% CI: 1.03-4.81; P = 0.042) were associated with poorer transplant survival. The key comorbidities that predict poorer 2-year survival outcomes after kidney transplantation have been identified in this large prospective cohort study. The findings will facilitate assessment of individual patient risks and evidence-based decision making.
Highlights
As disease reported by patient or as documented in the case notes, with or without ECG
Transient disease episode of neurologic dysfunction caused by ischaemia without infarction
Data for comorbidities were extracted from patient case notes, local electronic patient information systems and/or confirmed with the patients named consultant nephrologist at the time of recruitment to ATTOM
Summary
Angina – chest pain on exertion, relieved by rest or Glyceryl Trinitrate. As disease reported by patient or as documented in the case notes, with or without ECG changes, exercise tolerance testing or other imaging. Non-ST segment elevation myocardial infarction (NSTEMI) – troponin rise and non-ST segment elevation ischaemic ECG changes such as ST depression, T-wave inversion or no ECG changes. ST segment elevation myocardial infarction (STEMI) – troponin rise and ST segment elevation on ECG. Percutaneous coronary intervention (coronary angioplasty with or without stent insertion)
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