DOMINIC KEUSKAMP1,2, Dr CHRISTOPHER DAVIES1,2, ROBERT A BAKER3,4, KEVAN R POLKINGHORNE5,6, CHRISTOPHER M REID6,7, JULIAN A SMITH8,9, LAVINIA TRAN6, JENNI WILLIAMS-SPENCE6, RORY WOLFE6, STEPHEN P MCDONALD1,2,10
1Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, Australia, 2Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia, 3College of Medicine & Public Health, Flinders University, Bedford Park, Australia, 4Cardiac Surgery Quality & Outcomes Department, Flinders Medical Centre, Bedford Park, Australia, 5Department of Nephrology, Monash Health, Clayton, Australia, 6School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia, 7School of Population Health, Curtin University, Bentley, Australia, 8Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Australia, 9Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia, 10Central & Northern Adelaide Renal & Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia
Biography:
Dr Christopher Davies is the Lead Biostatistician at the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) within the South Australian Health and Medical Research Institute. At ANZDATA, Christopher provides statistical support for the generation of regular reports and the extraction of data for custom external requests. Christopher also conducts analyses for ANZDATA research projects and in collaboration with those in the nephrology community. Christopher completed a PhD in Statistics at the University of Adelaide, focussing on group-based trajectory modelling. His research interests include methods for comparing centres, and for longitudinal data.
Aim:
To estimate long-term patient and graft survival following cardiac surgery for people receiving kidney replacement therapy (KRT) and kidney transplant recipients (KTRs), respectively.
Background:
Kidney disease increases the risk of cardiovascular disease, sometimes requiring cardiac surgery. Long-term postoperative outcomes for these patients are poorly understood.
Methods:
Data were linked probabilistically between the Australia & New Zealand Dialysis & Transplant Registry and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons Cardiac Surgery Database. Time-to-event analyses were used to separately estimate the adjusted risk up to 10 years for (1) survival for people receiving KRT, and (2) graft survival for KTRs. All eligible surgeries from 2010-2019 were included (n= 1,488 people receiving KRT including n = 289 KTRs). Thirdly, using cardiac surgery as a time-varying covariate, postoperative graft survival was also compared among the prevalent Australian KTR population with graft survival to one year (n = 8,017).
Results:
Five-year survival probabilities post-surgery for people receiving dialysis and KTRs were 49% (95% CI 45,52) and 71% (64,77) respectively. Mortality risk was increased by a range of factors reflecting comorbidity, surgical complexity and longer KRT vintage. Five-year graft survival probability post-surgery was 61% (95% CI 54,67). Graft loss was strongly associated with stage 3 postoperative acute kidney injury (hazard ratio 2.50 [95% CI 1.38,4.55]). Among transplant recipients, surgery was associated with increased odds of graft failure (hazard ratio 1.63 [95% CI 1.05,2.53]).
Conclusions:
Functioning kidney transplantation at the time of surgery offered a benefit to long-term survival following cardiac surgery for people receiving KRT. However, KTRs undergoing cardiac surgery experienced higher odds of permanent graft loss than the prevalent transplant population.
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