Survival benefit of living donor kidney transplantation in patients on hemodialysis,Clinical and Experimental Nephrology

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Survival benefit of living donor kidney transplantation in patients on hemodialysis
Clinical and Experimental Nephrology ( IF 2.2 ) Pub Date : 2023-10-21 , DOI: 10.1007/s10157-023-02417-y
Shunsuke Goto _{1,

2} , Hideki Fujii ₁ , Makiko Mieno ₃ , Takashi Yagisawa ₄ , Masanori Abe _{2,

5} , Kosaku Nitta _{2,

6} , Shinichi Nishi ₁

Affiliation

Background

Donors bravely donate their kidneys because they expect that living donor kidney transplantation (LKT) confers benefits to recipients. However, the magnitude of the survival benefit of LKT is uncertain.

Methods

This prospective cohort study used two Japanese nationwide databases for dialysis and kidney transplantation and included 862 LKT recipients and 285,242 hemodialysis (HD) patients in the main model and 5299 LKT recipients and 151,074 HD patients in the supplementary model. We employed time-dependent model in the main model and assessed the hazard ratio and the difference in the restricted mean survival time (RMST) between LKT recipients and HD patients. In the main analysis of the main model (LKT, N = 675; HD, N = 675), we matched LKT recipients with HD patients by age, sex, dialysis vintage, and cause of renal failure and excluded HD patients with dementia or performance status grades 2, 3, or 4.

Results

The median observational period was 8.00 (IQR 3.58–8.00) years. LKT was significantly associated with a lower risk of mortality (hazard ratios (95% confidence interval (CI)), 0.50 (0.35–0.72)) and an increase in life expectancy (7-year RMST differences (95% CI), 0.48 (0.35–0.60) years) compared with HD. In subgroup analysis, the survival benefit of LKT was greater in female patients than in male patients in the Cox model; whereas older patients gained longer life expectancy compared with younger patients.

Conclusions

LKT was associated with better survival benefits than HD, and the estimated increase in life expectancy was 0.48 years for 7 years.

中文翻译：

活体肾移植对血液透析患者的生存获益

背景

捐献者勇敢地捐献自己的肾脏，因为他们期望活体肾移植（LKT）能给受者带来好处。然而，LKT 的生存获益程度尚不确定。

方法

这项前瞻性队列研究使用了两个日本全国透析和肾移植数据库，主要模型包括 862 名 LKT 接受者和 285,242 名血液透析 (HD) 患者，补充模型包括 5299 名 LKT 接受者和 151,074 名 HD 患者。我们在主模型中采用时间依赖模型，并评估 LKT 接受者和 HD 患者之间的风险比和限制平均生存时间 (RMST) 的差异。在主要模型（LKT， N = 675；HD， N = 675）的主要分析中，我们根据年龄、性别、透析年份和肾衰竭原因将 LKT 接受者与 HD 患者进行匹配，并排除患有痴呆或表现的 HD 患者状态等级 2、3 或 4。

结果

中位观察期为 8.00 (IQR 3.58–8.00) 年。 LKT 与较低的死亡风险（风险比（95% 置信区间 (CI)），0.50 (0.35–0.72)）和预期寿命的延长（7 年 RMST 差异（95% CI），0.48（ 0.35–0.60）年）与HD相比。亚组分析中，Cox 模型中女性患者 LKT 的生存获益大于男性患者；而与年轻患者相比，老年患者的预期寿命更长。