Multicenter registry analysis comparing survival on home hemodialysis and kidney transplant recipients in Australia and New Zealand

2020 ◽  
Author(s):  
Isabelle Ethier ◽  
Yeoungjee Cho ◽  
Carmel Hawley ◽  
Elaine M Pascoe ◽  
Matthew A Roberts ◽  
...  
Keyword(s):  
New Zealand ◽  
Treatment Failure ◽  
Kidney Transplant ◽  
Secondary Outcome ◽  
Organ Shortage ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Home Hemodialysis ◽  
Time To Treatment ◽  
Time To Treatment Failure

Abstract Background In the era of organ shortage, home hemodialysis (HHD) has been identified as the possible preferential bridge to kidney transplantation. Data are conflicting regarding the comparability of HHD and transplantation outcomes. This study aimed to compare patient and treatment survival between HHD patients and kidney transplant recipients. Methods The Australia and New Zealand Dialysis and Transplant Registry was used to include incident HHD patients on Day 90 after initiation of kidney replacement therapy and first kidney-only transplant recipients in Australia and New Zealand from 1997 to 2017. Survival times were analyzed using the Kaplan–Meier product-limit method comparing HHD patients with subtypes of kidney transplant recipients using the log-rank test. Adjusted analyses were performed with multivariable Cox proportional hazards regression models for time to all-cause mortality. Time-to-treatment failure or death was assessed as a composite secondary outcome. Results The study compared 1411 HHD patients with 4960 living donor (LD) recipients, 6019 standard criteria donor (SCD) recipients and 2427 expanded criteria donor (ECD) recipients. While LD and SCD recipients had reduced risks of mortality compared with HHD patients [LD adjusted hazard ratio (HR) = 0.57, 95% confidence interval (CI) 0.46–0.71; SCD HR = 0.65 95% CI 0.52–0.79], the risk of mortality was comparable between ECD recipients and HHD patients (HR = 0.90, 95% CI 0.73–1.12). LD, SCD and ECD kidney recipients each experienced superior time-to-treatment failure or death compared with HHD patients. Conclusions This large registry study showed that kidney transplant offers a survival benefit compared with HHD but that this advantage is not significant for ECD recipients.

scholarly journals P1431MULTI-CENTER REGISTRY ANALYSIS COMPARING SURVIVAL ON HOME HEMODIALYSIS AND KIDNEY TRANSPLANT RECIPIENTS IN AUSTRALIA AND NEW ZEALAND

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Isabelle Ethier ◽  
Yeoungjee Cho ◽  
Carmel Hawley ◽  
Elaine M Pascoe ◽  
Matthew A Roberts ◽  
...  
Keyword(s):  
New Zealand ◽  
Treatment Failure ◽  
Kidney Transplant ◽  
Secondary Outcome ◽  
Organ Shortage ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Home Hemodialysis ◽  
Time To Treatment ◽  
Time To Treatment Failure

Abstract Background and Aims In the era of organ shortage, home hemodialysis (HHD) has been identified as the possible preferential bridge to kidney transplantation. Data are conflicting regarding the comparability of HHD and transplantation outcomes. This study aimed to compare patient and treatment survival between HHD patients and kidney transplant recipients. Method The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident HHD patients on day 90 after initiation of kidney replacement therapy and first kidney-only transplant recipients in Australia and New Zealand from 1997 to 2017. Survival times were analyzed using the Kaplan-Meier product limit method comparing HHD patients to subtypes of kidney transplant recipients using the log-rank test. Adjusted analyses were performed with multivariable Cox proportional hazards regression models for time to all-cause mortality. Time-to-treatment failure or death was assessed as a composite secondary outcome. Results The study compared 1411 HHD patients to 4960 living donor (LD) recipients, 6019 standard criteria donor (SCD) recipients and 2427 expanded criteria donor (ECD) recipients. While LD and SCD recipients had reduced risks of mortality compared to HHD patients (LD adjusted hazard ratio [HR] 0.57, 95%CI 0.46-0.71; SCD HR 0.65 95%CI 0.52-0.79), the risk of mortality was comparable between ECD recipients and HHD patients (HR 0.90, 95%CI 0.73-1.12). LD, SCD and ECD kidney recipients each experienced superior time-to-treatment failure or death compared to HHD patients. Conclusion This large registry study showed that kidney transplant offers a survival benefit compared to HHD but that this advantage is not significant for ECD recipients.

scholarly journals Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand

2019 ◽  
Vol 14 (10) ◽  
pp. 1484-1492 ◽  
Author(s):  
Samuel Chan ◽  
Elaine M. Pascoe ◽  
Philip A. Clayton ◽  
Stephen P. McDonald ◽  
Wai H. Lim ◽  
...  
Keyword(s):  
New Zealand ◽  
T Cell ◽  
General Population ◽  
Kidney Transplant ◽  
Older Age ◽  
Competing Risk ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Female Sex ◽  
Related Mortality

Background and objectivesThe burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated.Design, setting, participants, & measurementsIn this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios.ResultsAmong 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997–2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997–2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011–2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20–30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011–2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997–2000), and use of T cell–depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76).ConclusionsInfection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell–depleting therapy, and deceased donor transplantation.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3

Cancer mortality in kidney transplant recipients: An Australian and New Zealand population‐based cohort study, 1980–2013

2020 ◽  
Vol 146 (10) ◽  
pp. 2703-2711 ◽  
Author(s):  
Brenda M. Rosales ◽  
Nicole De La Mata ◽  
Claire M. Vajdic ◽  
Patrick J. Kelly ◽  
Kate Wyburn ◽  
...  
Keyword(s):  
Cohort Study ◽  
New Zealand ◽  
Kidney Transplant ◽  
Cancer Mortality ◽  
Population Based ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Zealand Population

Pharmacist-Led Mobile Health Intervention and Transplant Medication Safety

2021 ◽  
pp. CJN.15911020
Author(s):  
Haley M. Gonzales ◽  
James N. Fleming ◽  
Mulugeta Gebregziabher ◽  
Maria Aurora Posadas-Salas ◽  
Zemin Su ◽  
...  
Keyword(s):  
Adverse Events ◽  
Confidence Interval ◽  
Kidney Transplant ◽  
Medication Errors ◽  
Risk Ratio ◽  
Mobile Health ◽  
Medication Safety ◽  
Secondary Outcome ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background and objectivesMedication safety events are predominant contributors to suboptimal graft outcomes in kidney transplant recipients. The goal of this study was to examine the efficacy of improving medication safety through a pharmacist-led, mobile health–based intervention.Design, setting, participants, & measurementsThis was a 12-month, single-center, prospective, parallel, two-arm, single-blind, randomized controlled trial. Adult kidney recipients 6–36 months post-transplant were eligible. Participants randomized to intervention received supplemental clinical pharmacist–led medication therapy monitoring and management via a mobile health–based application, integrated with risk-guided televisits and home-based BP and glucose monitoring. The application provided an accurate medication regimen, timely reminders, and side effect surveys. Both the control and intervention arms received usual care, including serial laboratory monitoring and regular clinic visits. The coprimary outcomes were to assess the incidence and severity of medication errors and adverse events.ResultsIn total, 136 kidney transplant recipients were included, 68 in each arm. The mean age was 51 years, 57% were male, and 64% were Black individuals. Participants receiving the intervention experienced a significant reduction in medication errors (61% reduction in the risk rate; incident risk ratio, 0.39; 95% confidence interval, 0.28 to 0.55; P<0.001) and a significantly lower incidence risk of Grade 3 or higher adverse events (incident risk ratio, 0.55, 95% confidence interval, 0.30 to 0.99; P=0.05). For the secondary outcome of hospitalizations, the intervention arm demonstrated significantly lower rates of hospitalizations (incident risk ratio, 0.46; 95% confidence interval, 0.27 to 0.77; P=0.005).ConclusionsWe demonstrated a significant reduction in medication errors, adverse events, and hospitalizations using a pharmacist-led, mobile health–based intervention.

scholarly journals Predictors of return to work after kidney transplantation: a 12-month cohort of the Japan Academic Consortium of Kidney Transplantation study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031231 ◽  
Author(s):  
Katsunori Miyake ◽  
Motoki Endo ◽  
Masayoshi Okumi ◽  
Kohei Unagami ◽  
Yoichi Kakuta ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Return To Work ◽  
Kidney Transplant ◽  
Outpatient Clinic ◽  
Multivariable Analysis ◽  
Secondary Outcome ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Male Sex ◽  
Managerial Position

ObjectivesTo investigate the cumulative return-to-work (RTW) rate and to identify predictors of employment after kidney transplantation (KT).DesignRetrospective, outpatient-based cohort study.SettingThis was a single-centre study of the largest Japanese kidney transplant centre.ParticipantsWe selected Japanese kidney transplant recipients aged 20–64 years who were employed in paid jobs at the time of transplantation and who visited an outpatient clinic from December 2017 to March 2018. From 797 patients, we evaluated 515 in this study.InterventionsWe interviewed patients at an outpatient clinic and investigated the timing and predictors of RTW using logistic regression models.Primary and secondary outcome measuresThe primary outcome was the cumulative RTW rate, and the secondary outcome was to investigate the predictors of RTW after KT.ResultsAmong the 515 included recipients, the cumulative overall partial/full RTW rates at 2, 4, 6 and 12 months were 22.3%, 59.0%, 77.1% and 85.0%, respectively. The median duration from transplantation to RTW was 4 months. Regarding partial/full RTW, according to the multivariable analysis including all variables, male sex was a greater predictor for RTW than female sex (OR 2.05, 95% CI 1.32 to 3.20), and a managerial position was a greater predictor than a non-managerial position (OR 2.23, 95% CI 1.42 to 3.52). Regarding full RTW, male sex (OR 1.95, 95% CI 1.25 to 3.06) and managerial position (OR 1.95, 95% CI 1.25 to 3.06) were also good predictors.ConclusionsThe cumulative RTW rate was 85.0% 1-year post-transplantation. Given that cumulative RTW rates varied by sex and position, transplant and occupational physicians should support kidney transplant recipients in the aspect of returning to work.Trial registration numberUMIN000033449

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