Survival of transplanted and dialysed patients in a French region with focus on outcomes in the elderly.
BACKGROUND
Impact of kidney transplantation on survival of French end-stage renal disease (ESRD) patients is unknown.


METHODS
A total of 1495 adults living in the Lorraine region and starting renal replacement therapy from 1997 to 2003 were included. A propensity score (PS) of registration on the renal transplant waiting list was estimated. Patient survival was studied using a time-dependent Cox multivariate regression and a Cox model stratified by PS tertiles. Survival of older patients (> or =60 years) was detailed.


RESULTS
Survival was associated with age, medical factors and transplantation. The hazard ratio (HR) of death for patients on dialysis compared to transplant recipients was 4.6 (95% CI: 2.9-7.2). The survival analysis stratified by PS was similar to the multivariate Cox model. The survival benefit of transplantation over dialysis persisted among elderly patients [HR: 4.6 (95% CI: 2.2-9.7)].


CONCLUSIONS
In a French community-based network, after taking into account comorbidities, transplantation was associated with longer survival even among elderly patients. Age per se should not therefore be considered as a contraindication to renal transplantation. However, elderly patients should be evaluated carefully before registration on the list. Medical guidelines should put forward a standard set of criteria for access to renal transplantation.
Bayat
Sahar
S
Department of Clinical Epidemiology and Evaluation, Nancy University, Vandoeuvre-lès-Nancy, France.
Kessler
Michèle
M
Briançon
Serge
S
Frimat
Luc
L
D000367:Age Factors; D000368:Aged; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014850:Waiting Lists