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Recipient comorbidity and survival outcomes after kidney transplantation : a UK-wide prospective cohort study
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Wu, Diana A., Robb, Matthew L., Forsythe, John L. R., Bradley, Clare, Cairns, John, Draper, Heather, Dudley, Christopher, Johnson, Rachel J., Metcalfe, Wendy, Ravanan, Rommel, Roderick, Paul, Tomson, Charles R. V., Watson, Christopher J. E., Bradley, J. Andrew and Oniscu, Gabriel C. (2019) Recipient comorbidity and survival outcomes after kidney transplantation : a UK-wide prospective cohort study. Transplantation, 104 (6). pp. 1246-1255. doi:10.1097/TP.0000000000002931 ISSN 0041-1337.
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Official URL: http://doi.org/10.1097/TP.0000000000002931
Abstract
Background: Comorbidity is increasingly common in kidney transplant recipients, yet the implications for transplant outcomes are not fully understood. We analysed the relationship between recipient comorbidity and survival outcomes in a UK-wide prospective cohort study – ATTOM.
Methods: 2100 adult kidney transplant recipients were recruited from all 23 UK transplant centers between 2011-2013. Data on 15 comorbidities were collected at the time of transplantation. Multivariable Cox regression models were used to analyse the relationship between comorbidity and 2-year graft survival, patient survival and transplant survival (earliest of graft failure or patient death) for deceased-donor kidney transplant (DDKT) recipients (n=1288) and living-donor kidney transplant (LDKT) recipients (n=812).
Results: For DDKT recipients, peripheral vascular disease (HR 3.04, 95%CI 1.37, 6.74, p=0.006) and obesity (HR 2.27, 95%CI 1.27, 4.06, p=0.006) were independent risk factors for graft loss, while heart failure (HR 3.77, 95%CI 1.79, 7.95, p=0.0005), cerebrovascular disease (HR 3.45, 95%CI 1.72, 6.92, p=0.0005) and chronic liver disease (HR 4.36, 95%CI 1.29, 14.71, p=0.018) were associated with an increased risk of mortality. For LDKT recipients, heart failure (HR 3.83, 95%CI 1.15, 12.81, p=0.029) and diabetes (HR 2.23, 95%CI 1.03, 4.81, p=0.042) were associated with poorer transplant survival.
Conclusion: The key comorbidities that predict poorer 2-year survival outcomes after kidney transplantation have been identified in this large prospective cohort study. The findings will facilitate assessment of individual patient risks and evidence-based decision making.
| Item Type: | Journal Article | ||||||||
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| Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Comorbidity , Kidneys -- Transplantation, Kidneys -- Transplantation -- Great Britain, Kidneys -- Diseases -- Patients -- Care, Chronic renal failure | ||||||||
| Journal or Publication Title: | Transplantation | ||||||||
| Publisher: | Lippincott Williams & Wilkins | ||||||||
| ISSN: | 0041-1337 | ||||||||
| Official Date: | 19 September 2019 | ||||||||
| Dates: |
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| Volume: | 104 | ||||||||
| Number: | 6 | ||||||||
| Page Range: | pp. 1246-1255 | ||||||||
| DOI: | 10.1097/TP.0000000000002931 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Reuse Statement (publisher, data, author rights): | "This is a non-final version of an article published in final form in Wu, Diana A., Robb, Matthew L., Forsythe, John L. R., Bradley, Clare, Cairns, John, Draper, Heather, Dudley, Christopher, Johnson, Rachel J., Metcalfe, Wendy, Ravanan, Rommel, Roderick, Paul, Tomson, Charles R. V., Watson, Christopher J. E., Bradley, J. Andrew and Oniscu, Gabriel C. (2019) Recipient comorbidity and survival outcomes after kidney transplantation : a UK-wide prospective cohort study. Transplantation . doi:10.1097/TP.0000000000002931 (In Press) | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 23 August 2019 | ||||||||
| Date of first compliant Open Access: | 2 September 2019 | ||||||||
| RIOXX Funder/Project Grant: |
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