Survival with dialysis versus kidney transplantation in adult hemolytic uremic syndrome patients

A fifteen-year study of the waiting list

Alfonso H. Santos, Michael J. Casey, Xuerong Wen, Ivan Zendejas, Shehzad Rehman, Karl L. Womer, Kenneth A. Andreoni

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background. Survival data are lacking for kidney transplant recipients with rare native end-stage renal disease (ESRD) etiologies. There is currently no large registry study comparing dialysis versus kidney transplantation survival outcomes of waitlisted adults with hemolytic uremic syndrome (HUS). Materials and Methods. We retrospectively studied adult-HUS end-stage renal disease patients (n = 559) placed on the US kidney transplant waitlist in 1996 to 2011. We analyzed 5-year transplantation and patient survival probabilities and risk factors using Kaplan-Meier and Cox hazards models, respectively. Using similar models, waitlist and transplantation outcomes of patients with diabetes mellitus (DM), hypertension (HTN), and glomerulonephritis (GN) were analyzed, and then compared with HUS patients. Results. Compared with waitlisted adult HUS patients on dialysis, 5-year mortality risks were 73% and 48% lower in recipients of living (hazard ratio [HR], 0.27, 95% confidence interval [95% CI], 0.11-0.65) and standard deceased (HR, 0.52; 95% CI, 0.29-0.94) donor kidney transplants, respectively. Mortality risks over 5 years were 44%, 50%, 54%, and 55% lower in the overall transplant recipient cohorts than in the dialysis-maintained cohorts within the HUS (HR, 0.56; 95% CI, 0.35-0.91), HTN (HR, 0.50; 95% CI, 0.48-0.52), GN (HR, 0.46; 95% CI, 0.44-0.49), and DM (HR, 0.45; 95% CI, 0.44-0.47) groups, respectively. Five-year transplantation probability in the waitlisted HUS cohort was 60% versus 42% to 49% (P < 0.001) in the DM and HTN cohorts, and 62% (P = 0.93) in the GN cohort. Conclusions. Living and standard criteria deceased donor kidney transplants provide significant survival benefit over dialysis in waitlisted adults with HUS. On the waitlist, the 5-year transplantation probability was higher in HUS than in DM and HTN patients.

Original languageEnglish (US)
Pages (from-to)2608-2616
Number of pages9
JournalTransplantation
Volume99
Issue number12
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Hemolytic-Uremic Syndrome
Waiting Lists
Kidney Transplantation
Dialysis
Survival
Confidence Intervals
Diabetes Mellitus
Glomerulonephritis
Transplantation
Hypertension
Kidney
Transplants
Proportional Hazards Models
Chronic Kidney Failure
Tissue Donors
Mortality
Registries

ASJC Scopus subject areas

  • Transplantation
  • Medicine(all)

Cite this

Survival with dialysis versus kidney transplantation in adult hemolytic uremic syndrome patients : A fifteen-year study of the waiting list. / Santos, Alfonso H.; Casey, Michael J.; Wen, Xuerong; Zendejas, Ivan; Rehman, Shehzad; Womer, Karl L.; Andreoni, Kenneth A.

In: Transplantation, Vol. 99, No. 12, 01.01.2015, p. 2608-2616.

Research output: Contribution to journalArticle

Santos, Alfonso H. ; Casey, Michael J. ; Wen, Xuerong ; Zendejas, Ivan ; Rehman, Shehzad ; Womer, Karl L. ; Andreoni, Kenneth A. / Survival with dialysis versus kidney transplantation in adult hemolytic uremic syndrome patients : A fifteen-year study of the waiting list. In: Transplantation. 2015 ; Vol. 99, No. 12. pp. 2608-2616.
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abstract = "Background. Survival data are lacking for kidney transplant recipients with rare native end-stage renal disease (ESRD) etiologies. There is currently no large registry study comparing dialysis versus kidney transplantation survival outcomes of waitlisted adults with hemolytic uremic syndrome (HUS). Materials and Methods. We retrospectively studied adult-HUS end-stage renal disease patients (n = 559) placed on the US kidney transplant waitlist in 1996 to 2011. We analyzed 5-year transplantation and patient survival probabilities and risk factors using Kaplan-Meier and Cox hazards models, respectively. Using similar models, waitlist and transplantation outcomes of patients with diabetes mellitus (DM), hypertension (HTN), and glomerulonephritis (GN) were analyzed, and then compared with HUS patients. Results. Compared with waitlisted adult HUS patients on dialysis, 5-year mortality risks were 73{\%} and 48{\%} lower in recipients of living (hazard ratio [HR], 0.27, 95{\%} confidence interval [95{\%} CI], 0.11-0.65) and standard deceased (HR, 0.52; 95{\%} CI, 0.29-0.94) donor kidney transplants, respectively. Mortality risks over 5 years were 44{\%}, 50{\%}, 54{\%}, and 55{\%} lower in the overall transplant recipient cohorts than in the dialysis-maintained cohorts within the HUS (HR, 0.56; 95{\%} CI, 0.35-0.91), HTN (HR, 0.50; 95{\%} CI, 0.48-0.52), GN (HR, 0.46; 95{\%} CI, 0.44-0.49), and DM (HR, 0.45; 95{\%} CI, 0.44-0.47) groups, respectively. Five-year transplantation probability in the waitlisted HUS cohort was 60{\%} versus 42{\%} to 49{\%} (P < 0.001) in the DM and HTN cohorts, and 62{\%} (P = 0.93) in the GN cohort. Conclusions. Living and standard criteria deceased donor kidney transplants provide significant survival benefit over dialysis in waitlisted adults with HUS. On the waitlist, the 5-year transplantation probability was higher in HUS than in DM and HTN patients.",
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T1 - Survival with dialysis versus kidney transplantation in adult hemolytic uremic syndrome patients

T2 - A fifteen-year study of the waiting list

AU - Santos, Alfonso H.

AU - Casey, Michael J.

AU - Wen, Xuerong

AU - Zendejas, Ivan

AU - Rehman, Shehzad

AU - Womer, Karl L.

AU - Andreoni, Kenneth A.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background. Survival data are lacking for kidney transplant recipients with rare native end-stage renal disease (ESRD) etiologies. There is currently no large registry study comparing dialysis versus kidney transplantation survival outcomes of waitlisted adults with hemolytic uremic syndrome (HUS). Materials and Methods. We retrospectively studied adult-HUS end-stage renal disease patients (n = 559) placed on the US kidney transplant waitlist in 1996 to 2011. We analyzed 5-year transplantation and patient survival probabilities and risk factors using Kaplan-Meier and Cox hazards models, respectively. Using similar models, waitlist and transplantation outcomes of patients with diabetes mellitus (DM), hypertension (HTN), and glomerulonephritis (GN) were analyzed, and then compared with HUS patients. Results. Compared with waitlisted adult HUS patients on dialysis, 5-year mortality risks were 73% and 48% lower in recipients of living (hazard ratio [HR], 0.27, 95% confidence interval [95% CI], 0.11-0.65) and standard deceased (HR, 0.52; 95% CI, 0.29-0.94) donor kidney transplants, respectively. Mortality risks over 5 years were 44%, 50%, 54%, and 55% lower in the overall transplant recipient cohorts than in the dialysis-maintained cohorts within the HUS (HR, 0.56; 95% CI, 0.35-0.91), HTN (HR, 0.50; 95% CI, 0.48-0.52), GN (HR, 0.46; 95% CI, 0.44-0.49), and DM (HR, 0.45; 95% CI, 0.44-0.47) groups, respectively. Five-year transplantation probability in the waitlisted HUS cohort was 60% versus 42% to 49% (P < 0.001) in the DM and HTN cohorts, and 62% (P = 0.93) in the GN cohort. Conclusions. Living and standard criteria deceased donor kidney transplants provide significant survival benefit over dialysis in waitlisted adults with HUS. On the waitlist, the 5-year transplantation probability was higher in HUS than in DM and HTN patients.

AB - Background. Survival data are lacking for kidney transplant recipients with rare native end-stage renal disease (ESRD) etiologies. There is currently no large registry study comparing dialysis versus kidney transplantation survival outcomes of waitlisted adults with hemolytic uremic syndrome (HUS). Materials and Methods. We retrospectively studied adult-HUS end-stage renal disease patients (n = 559) placed on the US kidney transplant waitlist in 1996 to 2011. We analyzed 5-year transplantation and patient survival probabilities and risk factors using Kaplan-Meier and Cox hazards models, respectively. Using similar models, waitlist and transplantation outcomes of patients with diabetes mellitus (DM), hypertension (HTN), and glomerulonephritis (GN) were analyzed, and then compared with HUS patients. Results. Compared with waitlisted adult HUS patients on dialysis, 5-year mortality risks were 73% and 48% lower in recipients of living (hazard ratio [HR], 0.27, 95% confidence interval [95% CI], 0.11-0.65) and standard deceased (HR, 0.52; 95% CI, 0.29-0.94) donor kidney transplants, respectively. Mortality risks over 5 years were 44%, 50%, 54%, and 55% lower in the overall transplant recipient cohorts than in the dialysis-maintained cohorts within the HUS (HR, 0.56; 95% CI, 0.35-0.91), HTN (HR, 0.50; 95% CI, 0.48-0.52), GN (HR, 0.46; 95% CI, 0.44-0.49), and DM (HR, 0.45; 95% CI, 0.44-0.47) groups, respectively. Five-year transplantation probability in the waitlisted HUS cohort was 60% versus 42% to 49% (P < 0.001) in the DM and HTN cohorts, and 62% (P = 0.93) in the GN cohort. Conclusions. Living and standard criteria deceased donor kidney transplants provide significant survival benefit over dialysis in waitlisted adults with HUS. On the waitlist, the 5-year transplantation probability was higher in HUS than in DM and HTN patients.

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