Kidney transplant prolongs life expectancy across patient ages compared to continued dialysis: JAMA
Austria: Kidney transplant lenthghens the survival time in kidney failure patients across all ages and waiting times, a recent study in JAMA Network Open has found. This implies that patients with kidney failure who are eligible for transplant should not be excluded from transplant programs on the basis of their age.
For eligible patients with kidney failure, kidney transplant is considered the optimal treatment strategy. Several studies have shown transplant to be cost-effective and improves survival than long-term dialysis. However available evidence from cohort studies is at high risk of bias and randomized clinical trials are infeasible.
Against the above background, Susanne Strohmaier, Medical University of Vienna, Vienna, Austria, and colleagues aimed to compare restricted mean survival times (RMSTs) between patients who underwent transplant and patients continuing dialysis across transplant candidate ages and applying target trial emulation methods depending on waiting time in a retrospective cohort study.
They addressed the question, "what is the difference in 10-year restricted mean survival time in kidney transplant recipients versus those remaining on the wait list and continuing dialysis for patients with kidney failure who are transplant eligible across different ages?"
The study evaluated patients aged 18 years or older who were in the wait list for their first single-organ deceased donor kidney transplant in Austria between January 1, 2000, and December 31, 2018. From the Austrian Dialysis and Transplant Registry and Eurotransplant, available data were obtained and included repeated updates on wait-listing status and relevant covariates. Data analysis was done from August 1, 2019, and December 23, 2021.
Emulation of a larger trial was done in which patients were randomized to receive either immediate transplant (treatment group) or to continue dialysis and never receive a transplant (control group) at each time of organ's availability. Time from transplant allocation to death was the study's main outcome.
The study led to the following findings:
- Among the included 4445 patients (66.9% were men; mean age, 52.2 years), transplant was associated with increased survival time across all considered ages compared with continuing dialysis and remaining on the wait list within a 10-year follow-up.
- The estimated RMST differences were 0.57 years at age 20 years, 3.01 years at age 60 years, and 2.48 years at age 70 years.
- The survival benefit for patients who underwent transplant across ages was independent of waiting time.
"We found a survival benefit for patients who receive a kidney transplant regardless of all ages of adults and time spent on the wait list and who are candidates for kidney transplant," the researchers wrote in their conclusion. "However, data for older transplant candidates are still sparse."
Reference:
Strohmaier S, Wallisch C, Kammer M, et al. Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure. JAMA Netw Open. 2022;5(10):e2234971. doi:10.1001/jamanetworkopen.2022.34971
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