WH LIM1, G WONG2, R MAINRA1
1Sir Charles Gairdner Hospital, Perth, WA, 2 Westmead Hospital, Sydney, NSW.
Aim: Determine the association between pre-transplant and de novo vascular disease burden and patient outcomes.
Background: Living donor (LD) kidney transplantation provides excellent patient and graft survival but there are little data regarding long-term outcome of LD kidney transplant recipients with pre-transplant or de novo vascular comorbidities.
Methods: Using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry, primary adult LD kidney transplant recipients between 1990 and 2014 were included. Mortality rates (expressed per 100 recipients) according to vascular disease burden and association with death with a functioning graft (DWFG) and all-cause mortality (ACM) were examined using adjusted Cox proportional hazards regression analyses. Time stratified model was conducted to examine vascular disease burden with ACM and DWFG.
Results: Of 4,742 patients, 3912 (82.5%), 428 (9%), 84 (1.8%) and 318 (6.7%) had no vascular disease, pre-transplant vascular disease at 1 site, ³2 sites and de novo vascular disease, respectively. Compared to no vascular disease, ACM rates between 0-1 and >1-5 years were 3.0 and 8.0 vs. 10.7 and 22.9 (per 100 recipients) for those with pre-transplant vascular disease at 1 and ³2 sites, respectively. Corresponding adjusted hazard rations are 2.06 (1.0, 4.23) and 1.80 (1.13, 2.86) vs. 6.97 (2.80, 17.35) and 3.29 (1.71, 6.31). ACM and DWFG for recipients with de novo vascular disease was greater only after 10-years post-transplant (26.6 and 23.9 per 100 recipients) with HR 1.47 (1.01, 2.16) and 2.05 (1.26, 3.34).
Conclusions: Pre- and post-transplant vascular disease burden portends a significant adverse impact on long-term patient survival in recipients of LD kidney transplants, with the survival disadvantage of those with de novo vascular disease not apparent until 10-years post-transplant.