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. 2016 Oct;100(10):2160-7.
doi: 10.1097/TP.0000000000001002.

Survival Benefit in Renal Transplantation Despite High Comorbidity

Vibeke Rømming Sørensen  1 , James Heaf, Sonja Wehberg, Søren Schwartz Sørensen
Affiliations

Survival Benefit in Renal Transplantation Despite High Comorbidity

Vibeke Rømming Sørensen et al. Transplantation. 2016 Oct.

Abstract

Background: The age and degree of comorbidity among transplant candidates is increasing. Knowledge of survival benefit in relation to recipient age and comorbidity is important, considering the scarcity of organs available for transplantation. The aim of the present study was to analyze the chances and survival benefit of transplantation among patients in different age groups and with different degrees of comorbidity score at the time of entering the waiting list.

Methods: Data from the Danish Nephrology Registry and Scandiatransplant were merged. Charlson Comorbidity Index scores were derived from the National Danish Admissions Registry. Study period is from January 1, 1995, to December 31, 2011. A multistate model was used to analyze the chance of having a renal transplantation and the effect of transplantation in different patients groups.

Results: Patients older than 65 years and patients with high comorbidity score had a decreased chance of being transplanted. However, if patients older than 65 years were transplanted with deceased donor, the mortality risk was reduced by 55% (hazard rate, 0.45 (0.26-0.75). In patients with a comorbidity score of 5 or greater, receiving a deceased donor transplant reduced the mortality risk by 72% (hazard rate, 0.28 (0.20-0.39). The overall survival benefit was 62% versus 70% in deceased versus living donor transplanted patients.

Conclusions: Poor health and old age reduced the chance of being transplanted. However, patients older than 65 years and patients with high comorbidity still had a survival benefit from renal transplantation.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Multi state model DDT, LDT.
FIGURE 2
FIGURE 2
Illustration of model fit. Cumulative hazards for mortality in patients remaining on the waiting list compared to transplanted patients based on stratified versus univariate Cox regression (common baseline).
FIGURE 3
FIGURE 3
Percentage of patients who were transplanted 1 to 5 and 10 years after entering the waiting list (based on the 3174 patients included, regardless of their time of risk).
FIGURE 4
FIGURE 4
Mortality (HR) according to transplant status and age group. Multivariate analysis of 3174 patients, with patients in the age group 18 to 44 years and never transplanted as the reference (HR = 1).
FIGURE 5
FIGURE 5
Mortality (HR) according to transplant status and CCI group Multivariate analysis of 3174 patients, with patients having a CCI of 2 and never transplanted as the reference (HR = 1).
FIGURE 6
FIGURE 6
Cumulative incidence of dying due to infection, cancer, hearts diseases, vascular diseases or other causes of death in patients on the WL, DDT, and LDT based on univariate Cox regression with time-dependent transplantation status. INF indicates infection; Ca, cancer; Heart, heart diseases; Vasc, vascular diseases.
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