An alternative approach to estimate age-related mortality of kidney transplant recipients compared to the general population: results in favor of old-to-old transplantations.
Compared to dialysis, kidney transplantation appears to be the best treatment for chronic kidney failure, even for older aged patients. Nevertheless, the individual benefit of transplanting elderly patients has to be balanced against the corresponding increase in the number of patients awaiting grafts. We analyzed the excess mortality related to kidney transplant recipients by taking into account the expected mortality of the general population (additive regression model for relative survival). We applied this method to a cohort of patients who received a first deceased-donor kidney transplant between 1998 and 2009 in France (DIVAT, n = 3641). Overall 10-year mortality was 13%. As expected, recipient age was the main risk factor associated with overall mortality. In contrast, recipient age was no longer significantly associated with the excess of mortality related to kidney transplant status by subtracting the expected mortality of the general population. Delayed graft function (DGF), pretransplantation immunization, and past history of diabetes appeared as the main risk factors of this higher mortality rate. Our results constitute a strong argument in favor of kidney transplantation, regardless of the patient's age. Preventing DGF may be more effective for decreasing the risk of death specifically attributable to the disease.
EA 4275 Biostatistics, Clinical Research and Subjective Measures in Health Sciences, Nantes University, Nantes, France; Institut de Transplantation Urologie Néphrologie (ITUN), Nantes Hospital and University, INSERM 1064, CENTAURE, Nantes, France.
Yohann
Y
Foucher
Ahmed
A
Akl
Vanessa
V
Rousseau
Katy
K
Trébern-Launay
Marine
M
Lorent
Michèle
M
Kessler
Marc
M
Ladrière
Christophe
C
Legendre
Henri
H
Kreis
Lionel
L
Rostaing
Nassim
N
Kamar
Georges
G
Mourad
Valérie
V
Garrigue
Emmanuel
E
Morelon
Fanny
F
Buron
Jean-Pierre
JP
Daurès
Jean-Paul
JP
Soulillou
Magali
M
Giral
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D051799:Delayed Graft Function; D005260:Female; D005602:France; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
aging; clinical epidemiology; kidney transplantation; mortality; relative survival