title: Role of pre-transplant marital status in renal transplant outcome.
abstract: BACKGROUND
  End-stage renal disease is associated with illness-induced disruptions that challenge patients and their families to accommodate and adapt. However, the impact of patients' marital status on kidney transplant outcome has never been studied. This project, based on data from United States Renal Data System (USRDS), helps to answer how marriage affects renal transplant outcome.
  
  
  METHODS
  Data have been collected from USRDS on all kidney/kidney-pancreas allograft recipients between January 1, 1995 and June 30, 2002, who were 18 yr old or older and had information about their marital status prior to the kidney transplantation (n = 2061). Survival analysis was performed using Kaplan-Meier methods and Cox proportional hazards modeling to control for confounding variables.
  
  
  RESULTS
  Overall findings of this study suggest that being married has a significant protective effect on death-censored graft survival [Hazard Ratio (HR) 0.80, p < 0.05] but a non-significant effect on recipient survival (HR 0.85, p = 0.122). When stratified by gender, the effect was still present in males for death-censored graft survival (HR 0.75, p < 0.05), but not for recipient survival (HR 0.86, p = 0.24). The effect was not observed in females, where neither graft (HR 0.90, p = 0.55) nor recipient (HR 0.8, p = 0.198) survival had an association with marital status. In subgroup analysis similar association was found in the recipients of a single transplant.
  
  
  CONCLUSIONS
  Based on our analysis, being married in the pre-transplant period is associated with positive outcome for the graft, but not for the recipient survival. When analyzed separately, the effect is present in male, but not in female recipients.
authors.affiliation: Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Naiman
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Baird
authors.forename: Ross B
authors.initials: RB
authors.lastname: Isaacs
authors.forename: James K
authors.initials: JK
authors.lastname: Koford
authors.forename: Arsalan N
authors.initials: AN
authors.lastname: Habib
authors.forename: Ben-jr
authors.initials: BJ
authors.lastname: Wang
authors.forename: Lev L
authors.initials: LL
authors.lastname: Barenbaum
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Goldfarb-Rumyantzev
mesh_terms: D000328:Adult; D005006:Ethnicity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000523:psychology*; D008297:Male; D017533:Marital Status; D008499:Medical Records; D008875:Middle Aged; D016016:Proportional Hazards Models; D044469:Racial Groups; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome