Publication: Survival in Southern European patients waitlisted for kidney transplant after graft failure: A competing risk analysis.
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Identifiers
Date
2018-03-07
Authors
Hernández, Domingo
Muriel, Alfonso
Castro de la Nuez, Pablo
Alonso-Titos, Juana
Ruiz-Esteban, Pedro
Duarte, Ana
Gonzalez-Molina, Miguel
Palma, Eulalia
Alonso, Manuel
Torres, Armando
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Abstract
Whether patients waitlisted for a second transplant after failure of a previous kidney graft have higher mortality than transplant-näive waitlisted patients is uncertain. We assessed the relationship between a failed transplant and mortality in 3851 adult KT candidates, listed between 1984-2012, using a competing risk analysis in the total population and in a propensity score-matched cohort. Mortality was also modeled by inverse probability weighting (IPTW) competing risk regression. At waitlist entry 225 (5.8%) patients had experienced transplant failure. All-cause mortality was higher in the post-graft failure group (16% vs. 11%; P = 0.033). Most deaths occurred within three years after listing. Cardiovascular disease was the leading cause of death (25.3%), followed by infections (19.3%). Multivariate competing risk regression showed that prior transplant failure was associated with a 1.5-fold increased risk of mortality (95% confidence interval [CI], 1.01-2.2). After propensity score matching (1:5), the competing risk regression model revealed a subhazard ratio (SHR) of 1.6 (95% CI, 1.01-2.5). A similar mortality risk was observed after the IPTW analysis (SHR, 1.7; 95% CI, 1.1-2.6). Previous transplant failure is associated with increased mortality among KT candidates after relisting. This information is important in daily clinical practice when assessing relisted patients for a retransplant.
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MeSH Terms
Adult
Cardiovascular Diseases
Cause of Death
Cohort Studies
Europe
Graft Survival
Humans
Kidney Transplantation
Propensity Score
Registries
Risk Assessment
Risk Factors
Survival Analysis
Survival Rate
Treatment Failure
Waiting Lists
Cardiovascular Diseases
Cause of Death
Cohort Studies
Europe
Graft Survival
Humans
Kidney Transplantation
Propensity Score
Registries
Risk Assessment
Risk Factors
Survival Analysis
Survival Rate
Treatment Failure
Waiting Lists