Transcript IS HIGHER CO-MORBIDITY THE EXPLANATION FOR THE …

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IS HIGHER CO-MORBIDITY THE
EXPLANATION FOR THE INCREASED
MORTALITY IN “NEVER TRANSPLANTED”
WAITING LIST PATIENTS COMPARED TO
RENAL TRANSPLANTED PATIENTS?
Vibeke Rømming Sørensen, Department of Nephrology, Rigshospitalet
James Heaf, Department of Nephrology, Herlev Hospital
Søren Schwartz Sørensen, Department of Nephrology, Rigshospitalet
BACKGROUND
• Well known that the observed survival in
transplanted patients is much better than in
never transplanted patients on the waiting-list
treated with dialysis
• Hovewer no randomized studies proving the
benefit of renal transplantation exist
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BACKGROUND
• The number of available organs from
deceased donors have not kept pace with the
number of patients on the waiting list
• The fact that every year a number of patients
die while waiting for a kidney is offen debated
in the media
• Could these patients have been saved if
more organs were available ?
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AIM
Among patients on the waiting-list compared to
transplanted patients to describe:
• co-morbidity
• mortality
• causes of dead
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MATERIALS AND METHODS
• Data from Danish Nephrology Registry and the
database Scandiatransplant were combined.
• Charlson Comorbidity Index (CCI) scores were
derived from the National Danish Admissions
Registry, which records all discharge
diagnoses.
• Study period was: 01.01.1995 - 01.01.2012.
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SUBJECTS
Patients were divided into 3 groups:
1. Waiting list group (WL) i.e. never transplanted
2. Transplanted with deceased donor (DDTx)
3. Transplanted with a living donor (LDTx).
Only patients waiting for or receiving their first renal
transplant were included. For the purposes of this study,
withdrawal from the waiting list was not studied, since the
data regarding this phenomenon is limited
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RESULTS
WL
DDTx
LDTx
N
734
1534
960
Sex (female %)
38
38
38
ESRD age (yr)
50.6 ±12cC
44.8 ±14
37.7 ±15
WL age (yr)
52.0 ±11cC
45.9 ±14
38.2 ±15
47.5 ±143
38.8 ±16
1.02 ±1.53
0.50 ±1.2
Tx age (yr)
Time from ESRD to
WL (YR)
Time from WL to RT
(yr)
1.38 ±1.9cC
1.64 ±1.9
0.55 ±1.4
WL vs. DDTx: a:p<0.05; b:p<0.01; c: p<0.001. WL vs. LDTx: A:p<0.05; B:p<0.01;
C: p<0.001. DDTx vs. LDTx: : 1:p<0.05; 2:p<0.01; 3: p<0.001.
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Charlson co-morbidity index
Charlson Co-morbidity Index
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P<0.001
3.5
P<0.001
3
2.5
WL
2
DDTx
1.5
DLTx
1
0.5
0
CCI score at the
time of ESRD
CCI score at the
time of entering
WL
CCI score at the
time of RT
All patients automatically receive two CCI points because of end stage renal failure (ESRD)
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Causes of death
(according to DNS database)
30
25
20
% 15
10
5
0
WL
DDTx
LDTx
WL versus DDTx: NS , WL versus LDTx: NS
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Cardiovascular death in among WL-patients,
DDTx-patients and LDTx-patients
100%
80%
60%
40%
20%
45
39
26
0%
WL
DDTx
CV-death
LDTx
Non-Cv death
WL versus DDTx p=0.09 , WL versus LDTx p< 0.01
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Observed survival in WL-patients, DDTx patients and LDTx patients
1,0
0,9
LDTx
Cumulative Proportion Surviving
0,8
0,7
0,6
DDTx
0,5
0,4
P < 0. 0001
0,3
0,2
WL
0,1
0,0
0
2
4
6
8
10
12
14
16
18
20
Y ears
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Multivariate regression analysis
Correction for age, sex, renal diagnosis, comorbidity and cohort (patients receiving a
deceased donor transplant had a defined relative
mortality risk of 1.)
WL patientes: HR= 3,32 (2,81-3,82)p < 0.001
LDTx patients: HR= 0,70 (0,56-0,87) p< 0.01
CONCLUSION
Is higher co-morbidity the explanation for the increased
mortality in “never transplanted” waiting list patients
compared to renal transplanted patients ?
• YES, WL are older and have a significanty higher CCI score
at ESRD and time of entering the waiting list
• NO, However when correction for this together with (age,
sex, renal diagnosis and cohord) stil mortality 3 times
higher in WL patients compared to DDTx patients
• Maybe, Having a high co-morbidity when entering the WL,
even after going though the præ-transplantation
programe, increases the risk of being in the ”never
transplanted” group
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