title: Survival With Dialysis Versus Kidney Transplantation in Adult Hemolytic Uremic Syndrome Patients: A Fifteen-Year Study of the Waiting List.
abstract: BACKGROUND
  Survival data are lacking for kidney transplant recipients with rare native end-stage renal disease (ESRD) etiologies. There is currently no large registry study comparing dialysis versus kidney transplantation survival outcomes of waitlisted adults with hemolytic uremic syndrome (HUS).
  
  
  METHODS
  We retrospectively studied adult-HUS end-stage renal disease patients (n = 559) placed on the US kidney transplant waitlist in 1996 to 2011. We analyzed 5-year transplantation and patient survival probabilities and risk factors using Kaplan-Meier and Cox hazards models, respectively. Using similar models, waitlist and transplantation outcomes of patients with diabetes mellitus (DM), hypertension (HTN), and glomerulonephritis (GN) were analyzed, and then compared with HUS patients.
  
  
  RESULTS
  Compared with waitlisted adult HUS patients on dialysis, 5-year mortality risks were 73% and 48% lower in recipients of living (hazard ratio [HR], 0.27, 95% confidence interval [95% CI], 0.11-0.65) and standard deceased (HR, 0.52; 95% CI, 0.29-0.94) donor kidney transplants, respectively. Mortality risks over 5 years were 44%, 50%, 54%, and 55% lower in the overall transplant recipient cohorts than in the dialysis-maintained cohorts within the HUS (HR, 0.56; 95% CI, 0.35-0.91), HTN (HR, 0.50; 95% CI, 0.48-0.52), GN (HR, 0.46; 95% CI, 0.44-0.49), and DM (HR, 0.45; 95% CI, 0.44-0.47) groups, respectively. Five-year transplantation probability in the waitlisted HUS cohort was 60% versus 42% to 49% (P < 0.001) in the DM and HTN cohorts, and 62% (P = 0.93) in the GN cohort.
  
  
  CONCLUSIONS
  Living and standard criteria deceased donor kidney transplants provide significant survival benefit over dialysis in waitlisted adults with HUS. On the waitlist, the 5-year transplantation probability was higher in HUS than in DM and HTN patients.
authors.affiliation: 1 Division of Nephrology, Department of Medicine, University of Florida, Gainesville, FL. 2 Division of Abdominal Transplant Surgery, Department of Surgery, University of Florida, Gainesville, FL.
authors.forename: Alfonso H
authors.initials: AH
authors.lastname: Santos
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Casey
authors.forename: Xuerong
authors.initials: X
authors.lastname: Wen
authors.forename: Ivan
authors.initials: I
authors.lastname: Zendejas
authors.forename: Shehzad
authors.initials: S
authors.lastname: Rehman
authors.forename: Karl L
authors.initials: KL
authors.lastname: Womer
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Andreoni
mesh_terms: D000328:Adult; D005260:Female; D005431:Florida / Q000453:epidemiology; D005544:Forecasting; D006463:Hemolytic-Uremic Syndrome / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D066027:Transplant Recipients; D014850:Waiting Lists / Q000401:mortality*