BOSTON — Kidney transplant recipients with a failing graft had an increased risk for both mortality and morbidity compared to patients who had a similar degree of kidney dysfunction but no transplant, according to a speaker at the American Transplant Congress.
“Unfortunately, kidney grafts have a finite lifetime to them,” Ngan Lam, MD, MSc, FRCPC, assistant professor in the division of nephrology at the University of Alberta, said during an abstract presentation. “Approximately one in five kidney transplant patients will experience graft failure within the first 5 years, and kidney transplant patients with a failing graft make up about 5% of dialysis patients every year in Canada and the United States. It is one of the top five reasons for starting dialysis.”
To examine mortality and morbidity related to a failing graft, researchers conducted a retrospective cohort study of 520 kidney transplant recipients (median age, 57 years; 40% were women) who had a failing graft (defined as at least two eGFR measurements between 15 mL/min/1.73 m2 to 30 mL/min/1.73 m2 that were 90 to 365 days apart). These patients were matched to non-transplant controls who had a similar degree of chronic kidney disease. Hazards of mortality and rates of hospitalization were compared. Patients were followed for a median of 5 years.
Researchers found 40% of transplant recipients with a failing graft experienced mortality compared with 27% of non-transplant recipients (HR = 1.54) and that transplant recipients also had a higher rate of all-cause hospitalization (rate ratio = 1.67).
In addition, it was observed that kidney transplant recipients had a higher rate of cause-specific hospitalizations including genitourinary, cardiovascular and infectious causes.
Some of the reasons that kidney transplant patients with a failing graft had more adverse outcomes than non-transplant patients may include the fact that they have had a longer duration of CKD, greater exposure to immunosuppression and more comorbidities, according to Lam.
“This information can be used to discuss the prognosis with kidney transplant patients and, since we don’t definitively know what the best time is to start dialysis, what the best modality is or what the best access is for these patients, these findings highlight that further research is needed to try to figure out what the optimal strategy is as we transition patients through this period,” Lam said. – by Melissa J. Webb
Lam N, et al. Abstract 7. Presented at: American Transplant Congress. June 1-5, 2019; Boston.
Disclosure: Lam reports no relevant financial disclosures.