Better kidney allograft survival despite higher-risk donor and recipient characteristics between 1995-2014

Monica Suet Ying Ng; Andrew Thomas Jones; Andrew John Mallett; Michelle Marie O'Shaughnessy

doi:10.1093/ndt/gfae081

Better kidney allograft survival despite higher-risk donor and recipient characteristics between 1995-2014

Nephrol Dial Transplant. 2024 Apr 4:gfae081. doi: 10.1093/ndt/gfae081. Online ahead of print.

Authors

Monica Suet Ying Ng^{1

2

3}, Andrew Thomas Jones^{4

5}, Andrew John Mallett^{2

6

7

8}, Michelle Marie O'Shaughnessy⁹

Affiliations

¹ Kidney Health Service, Royal Brisbane And Women's Hospital, Brisbane, Australia.
² Faculty of Medicine, University Of Queensland, Brisbane, Australia.
³ Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Brisbane, Australia.
⁴ Queensland Cyber Infrastructure Foundation, Brisbane, Australia.
⁵ Centre for Health Services Research, Faculty of Medicine, University Of Queensland, Brisbane, Australia.
⁶ College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
⁷ Institute of Molecular Biosciences, University Of Queensland, Brisbane, Australia.
⁸ Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia.
⁹ Department of Medicine, University of Galway, Galway, Ireland.

PMID: 38573827
DOI: 10.1093/ndt/gfae081

Abstract

Background and hypothesis: Advances in organ procurement, surgical techniques, immunosuppression regimens and prophylactic antibiotic therapies have dramatically improved short term kidney transplant graft failure. It is unclear how these interventions have affected longer term graft failure. It is hypothesised that graft failure has improved over the last 20 years.

Methods: Data on all first kidney transplants from 1995-2014 were extracted from the Australia and New Zealand Dialysis and Transplant Registry with follow-up as of 31 December, 2021. Primary exposure was transplant era, classified into 5-year intervals. Primary outcome was all-cause 5-year graft failure. Secondary outcomes included all-cause 10-year graft failure and cause-specific graft failure. Kaplan Meier curves and multivariable Cox Proportional Hazards Regression models were used to assess trends in all-cause graft failure. Fine-Gray subdistribution hazard models verified that changes in death rates were not biasing the Cox Proportional Hazards Regression models. Cumulative incidence functions were used to assess temporal trends in cause-specific graft failure.

Results: Across 10 871 kidney transplants, there was a shift towards transplanting more recipients aged over 45 years old, with more comorbidities, longer dialysis vintage, body mass index greater than 30 kg/m2 and greater human leukocyte antigen mismatches. Donor age has increased but no clear shift in donor source was observed. Compared to 1995-1999 (reference), the adjusted hazard ratio for 5-year graft failure was 0.78 (95% CI 0.67-0.91), 0.70 (95% CI 0.59-0.83) and 0.60 (95% CI 0.50-0.73) for 2000-2004, 2005-2009, and 2010-2014, respectively. Ten-year graft failure similarly reduced from 0.83 (95% CI 0.74-0.93) for 2000-04 to 0.78 (95% CI 0.68-0.89) for 2010-14, compared to 1995-99.

Conclusion: Medium and long term all-cause graft failure has improved steadily since 1995-99. Significant reductions in graft failure due to rejection and vascular causes were observed at 5 years, and due to rejection, vascular causes, death and glomerular disease at 10 years.

Keywords: ANZDATA; graft failure; graft survival; kidney transplant; registry.