Comparison of Survival Probabilities for Dialysis Patients vs Cadaveric Renal Transplant Recipients

TLDR

The study compared mortality risk between cadaveric renal transplant recipients and dialysis candidates in the cyclosporine era using a statewide cohort of Michigan residents under 65 who initiated ESRD therapy between 1984 and 1989. Patients (n = 5020) were followed from ESRD onset to wait‑listing, transplantation, and study end, and a time‑dependent analysis adjusting for age, sex, race, and ESRD cause was used to estimate relative risk of death. Transplantation initially increased mortality risk but conferred a long‑term survival advantage (RR = 0.36 after 365 days), most pronounced in diabetics (RR = 0.25), with equal mortality reached after ~117 days and equal cumulative mortality after ~325 days, demonstrating overall long‑term benefit over dialysis.

Abstract

To compare mortality risk among cadaveric renal transplant recipients vs transplant candidates on dialysis in the cyclosporine era.Patient mortality risk was analyzed by treatment modality for a completed statewide patient population.All Michigan residents younger than age 65 years who started endstage renal disease (ESRD) therapy between January 1, 1984, and December 31, 1989, were included. Patients were followed up from ESRD onset (n = 5020), to wait-listing for renal transplant (n = 1569), to receiving a cadaveric first transplant (n = 799), and to December 31, 1989.Mortality rates.Using a time-dependent variable based on the waiting time from date of wait-listing to transplantation and adjusting for age, sex, race, and primary cause of ESRD, the relative risk (RR) of dying was increased early after transplantation and then decreased to a beneficial long-term effect, given survival to 365 days after transplantation (RR, 0.36; P < .001). This lower long-term risk was most pronounced (RR, 0.25) among diabetic transplant recipients compared with diabetic wait-listed dialysis patients (P < .001) and not observed among patients with glomerulonephritis as cause of ESRD (P > .05). Overall, the estimated times from transplantation to equal mortality risk was 117 +/- 28 days and to equal cumulative mortality was 325 +/- 91 days.The overall mortality risk following renal transplantation was initially increased, but there was a long-term survival benefit compared with similar patients on dialysis. These analyses allow improved description of comparative mortality risks for dialysis and transplant patients and allow advising patients regarding comparative survival outcomes.