C. Y. Wu1, A. C. Thorsen1, T. Galvan1, A. Rana1 1Baylor College Of Medicine,Division Of Abdominal Transplantation,Houston, TX, USA
Introduction: : Kidney transplant is the most common solid organ transplant and an important life-prolonging treatment. Over the past three decades, there have been many advances in kidney transplant patient selection and management. However, there has not been research if these gains have impacted overall patient survival outcomes. This project aimed to look at all kidney transplant data over the past 30 years and determine if long-term outcomes if patient survived >1 year and short-term outcomes <1 year have improved over time. This would allow greater evaluation of the significance of progress of survival outcomes in recent kidney transplant history.
Methods: This project retrospectively analyzed 370,959 adult (>18 years) patients who received kidney transplants between 1987 to 2017 using the United Network for Organ Sharing (UNOS) database. The collected data was analyzed using the STATA statistical software. The Kaplan-Meier method for time-to-event analysis and multivariable Cox regression were employed to estimate survival. Additional variables and a cause of death analysis were also included.
Results: Unadjusted long-term outcomes among 1-year survivors over the past 30 years have improved steadily over time. Compared with the reference range 2011 to 2017, time periods starting from 1987 were found to have decreased hazard ratios (p<.001), indicating that a transplant now has a greater likelihood of long-term survival than 30 years ago. From 1987-1990 (HR 1.52, CI 1.47–1.57) and 1991-1995 (HR 1.18, CI 1.17-1.20), the risk of failure compared to the current decade has decreased to 2001-2005 (HR 1.08, CI 1.08-1.09) and 2006-2010 (HR 1.05, CI 1.04-1.05). [GEA1] Other controlling variables include age of recipient BMI, male sex, dialysis, previous transplant, hospital status, GFR of recipient and age of donor that influenced long-term patient survival. The highest reported causes of death in these patients were meningitis, overdose and spontaneous cranial bleed.
Conclusion: Over the last 30 years there has been appreciable gains in long-term survival of kidney transplant recipients. The UNOS database proved to be a powerful tool in understanding trends in kidney transplants. Further research should be performed to determine what specific factors have led the long-term survival of patients in recent decades should be conducted.
