Mortality after kidney transplantation: a comparison between the United States and Canada.
There is a paucity of comparative studies on country-specific outcomes in kidney transplantation. We compared post-transplant mortality among primary, adult, solitary kidney transplant recipients (KTR) from the United States (n = 70 708) and Canada (n = 5773), between January 1, 1991 and December 31, 1998, using data from the Scientific Registry of Transplant Recipients and the Canadian Organ Replacement Register. Multivariable Cox regression revealed higher adjusted post-transplant mortality among U.S. (vs. Canadian) KTR (HR = 1.35 [95% CI 1.24, 1.47; p < 0.005]). Mortality risk in the first post-transplant year was similar in both countries but higher in the United States beyond the first year (HR = 1.49-1.53; p < 0.005). There was no difference in mortality among patients transplanted within 1 year of starting dialysis, but mortality was increased in U.S. (vs. Canadian) patients after 1-2 and 4+ years on dialysis (HR = 1.36-1.66; p < 0.005). Greater mortality was also seen in U.S. patients with diabetes mellitus and/or graft failure. In conclusion, there are considerable differences in the survival of KTR in the United States and Canada. A detailed examination of factors contributing to this variation may yield important insights into improving outcomes for all KTR.
Kim
S J
SJ
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Schaubel
D E
DE
Fenton
S S A
SS
Leichtman
A B
AB
Port
F K
FK
D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D014481:United States