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Optimizing waiting duration for renal transplants in the setting of renal malignancy: Is 2-years too long to wait?

Nephrology Dialysis Transplantation Aug 28, 2017

Nguyen KA, et al. – Objective was to improve decision making, to accomplish that experts assessed the impact of waiting duration on the outcomes of kidney cancer patients awaiting renal transplantation. While non–cancer–specific mortality (NCSM) significantly improved with shorter wait times, waiting duration did not influence cancer–specific mortality (CSM).

Methods

  • In order to determine patients with a known cause of end-stage renal disease (ESRD) from 1983 to 2007, this study used the United States Renal Data System.
  • With Kaplan–Meier estimates and Cox proportional hazards models, evaluation of overall survival (OS) was performed.
  • Cancer-specific mortality (CSM) and non-cancer-specific mortality (NCSM) were appraised using fine–Gray competing risk models.

Results

  • 228984 (16.7%) received transplantation, among 1374175 patients with ESRD.
  • As compared to those with other known causes of ESRD, transplant recipients with renal malignancy–associated ESRD (RM-ESRD) had longer waiting durations (2.4 versus 1.3 years; P<0.0001).
  • With similar CSM (10-year CSM 10.3 versus 10.2%, respectively; P=0.883), RM-ESRD patients who had shorter waiting durations (0–2 years) had better OS than those who waited longer (2+ years) (10-year OS 69.0 versus 46.7%, respectively; P<0.0001).
  • Results revealed worse NCSM for those with longer waiting durations (10-year NCSM 20.7 versus 44.3%, respectively; P<0.0001).
  • On Cox modeling, it was found that the status of RM-ESRD was not a significant predictor (P=0.07), while longer waiting duration remained significant (P<0.0001).

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