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September 15, 1993

Comparison of Survival Probabilities for Dialysis Patients vs Cadaveric Renal Transplant Recipients

Author Affiliations

From the Michigan Kidney Registry and Departments of Internal Medicine (Drs Port and Berling), Epidemiology (Dr Port), and Biostatistics (Drs Wolfe and Jiang and Ms Mauger), University of Michigan Schools of Medicine and Public Health, Ann Arbor. Dr Berling is now with Carolina Nephrology Associates, Charlotte, NC, and Dr Jiang is now with Merck Research Associates, West Point, Pa.

JAMA. 1993;270(11):1339-1343. doi:10.1001/jama.1993.03510110079036

Objective.  —To compare mortality risk among cadaveric renal transplant recipients vs transplant candidates on dialysis in the cyclosporine era.

Setting.  —Patient mortality risk was analyzed by treatment modality for a completed statewide patient population.

Patients.  —All Michigan residents younger than age 65 years who started end-stage renal disease (ESRD) therapy between January 1,1984, and December 31, 1989, were included. Patients were followed up from ESRD onset (n=5020), to wait-listing for renal transplant (n=1569), to receiving a cadaveric first transplant (n=799), and to December 31, 1989.

Main Outcome Measure.  —Mortality rates.

Results.  —Using a time-dependent variable based on the waiting time from date of wait-listing to transplantation and adjusting for age, sex, race, and primary cause of ESRD, the relative risk (RR) of dying was increased early after transplantation and then decreased to a beneficial long-term effect, given survival to 365 days after transplantation (RR, 0.36; P<.001). This lower long-term risk was most pronounced (RR, 0.25) among diabetic transplant recipients compared with diabetic wait-listed dialysis patients (P<.001) and not observed among patients with glomerulonephritis as cause of ESRD (P>.05). Overall, the estimated times from transplantation to equal mortality risk was 117±28 days and to equal cumulative mortality was 325±91 days.

Conclusions.  —The overall mortality risk following renal transplantation was initially increased, but there was a long-term survival benefit compared with similar patients on dialysis. These analyses allow improved description of comparative mortality risks for dialysis and transplant patients and allow advising patients regarding comparative survival outcomes.(JAMA. 1993;270:1339-1343)