Journal Article

Preemptive renal transplant candidate survival, access to care, and renal function at listing

Rachel B. Fissell, Titte Srinivas, Rich Fatica, Joseph Nally, Sankar Navaneethan, Emilio Poggio, David Goldfarb and Jesse Schold

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 8, pages 3321-3329
Published in print August 2012 | ISSN: 0931-0509
Published online March 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs012
Preemptive renal transplant candidate survival, access to care, and renal function at listing

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Background

Preemptive transplantation is associated with better survival and transplant outcomes than transplantation after dialysis has been started. The purpose of this study is to examine associations between candidate characteristics, likelihood of preemptive transplant, candidate survival and renal function (RF) at the time of listing.

Methods

We looked at 57 677 solitary renal transplant candidates from the Scientific Registry of Transplant Recipients database listed prior to dialysis from 2000 to 2009. Using multivariable models, we measured associations between candidate characteristics, likelihood of preemptive transplantation, candidate survival and RF at listing.

Results

Candidates with higher RF at listing were more likely to be male, Caucasian, diabetic, be a prior transplant recipient and have more education. Higher RF at listing was strongly associated with greater likelihood of receipt of preemptive transplant [adjusted odds ratio = 1.45, 95% confidence interval (CI) 1.38–1.51] and conferred a significant survival advantage [adjusted hazards ratio = 0.84, 95% CI 0.79–0.89, per 5 mL/min/1.73 m2].

Conclusions

Patient characteristics associated with higher RF at listing suggest differences in access to care. Given that higher RF at the time of listing was also significantly associated with greater likelihood of preemptive transplantation and better survival prior to transplantation, our results suggest that listing at higher levels of RF may improve transplant candidate outcomes.

Keywords: epidemiology; preemptive; renal function; transplant

Journal Article.  4513 words.  Illustrated.

Subjects: Nephrology

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