KIDNEY TRANSPLANT GRAFT OUTCOMES OVER 20 YEARS – IMPROVEMENTS IN GRAFT SURVIVAL DESPITE TRANSPLANTING HIGHER RISK DONOR AND RECIPIENTS
Monica Suet Ying Ng1,2,3, AT JONES4,5, AJ MALLETT6,2,7,8, M O’SHAUGHNESSY9 1Kidney Health Service, Royal Brisbane And Women’s Hospital, Brisbane, Queensland, Australia2Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia3Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia4Queensland Cyber Infrastructure Foundation, Brisbane, Queensland, Australia5Centre for Health Services Research, Faculty of Medicine, University Of Queensland, Brisbane, Queensland, Australia6College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia7Institute of Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia8Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia9Department of Nephrology, Galway University Hospital, Galway, Ireland
Abstract
Aim
We aimed to determine temporal trends in patient characteristics and allograft survival in patients receiving a first kidney transplant between 1995 and 2014.
Background
Advances in organ procurement, surgical techniques, immunosuppression regimens and prophylactic antibiotic therapies have dramatically improved short term kidney transplant outcomes. However, temporal trends in longer-term allograft outcomes are less clear.
Methods
Data on all first kidney transplants performed between 1995 and 2014 were extracted from the Australia and New Zealand Dialysis and Transplant Registry. Primary exposure was transplant era, classified into 5-year intervals. Primary outcome was all-cause allograft failure and secondary outcome was cause of allograft failure. Kaplan Meier survival curves and multivariable Cox Proportional Hazards Regression models were used to determine associations between era and all-cause allograft failure. Cumulative incidence functions and Fine-Gray subdistribution hazard models were used to assess the impact of competing risks and changes on the rates of cause-specific graft failure across transplant eras.
Results
Across 13,016 kidney transplants, there was a shift towards transplanting more people of older age, with more comorbidities, longer dialysis vintage, higher body mass index, and more human leukocyte antigen mismatches in more modern eras. Despite transplanting a higher-risk patient cohort, we saw a significant association between more recent era and better transplant survival, for both unadjusted and adjusted analyses. Compared to 1995-1999 (reference), the adjusted hazard ratio for 5-year graft failure reduced from 0.78 (95% CI 0.67-0.91) for 2000-04 to 0.60 (95% CI 0.50-0.73) for 2010-14 – primarily attributed to less graft failure due to rejection.
Conclusions
Medium term all-cause graft failure has improved steadily since 1995-99. Temporal trends for causes of kidney failure will be examined in further investigations.
Biography
Dr Monica Ng is a renal registrar at Royal Brisbane and Women’s Hospital, editorial fellow at Kidney360 and early career clinician scientist. Dr Ng graduated from UQ in 2014 with MBBS with first class honours. She completed her PhD studies in 2019. Dr Ng’s postdoctoral work into developing omics workflows for kidney biomarker discovery and registry analysis for contributors of kidney disease are being completed in conjunction with kidney advanced training. Her long term goals include developing into an independent clinician scientist with research interests in biomarker discovery, kidney immunology and glomerular disease.
Shaun Summers Clinical Trainee Award Presentation PDF Slides