Excess Stroke Deaths in Kidney Transplant Recipients: A Retrospective Population-based Cohort Study Using Data Linkage

Background: Understanding rates of mortality in kidney transplant recipients relative to other common diseases can enhance our understanding of the mortality burden in kidney transplant recipients. Objective: To compare the survival probability in Canadian female and male kidney transplant recipients with patients with common cancers (female: breast, colorectal, lung, or pancreas; male: prostate, colorectal, lung, or pancreas) in a contemporary population. Design: Population-based cohort study using linked administrative health care databases. Setting: Ontario, Canada. Patients: A total of 6888 incident kidney transplant recipients (median age was 50 and 51 years in females and males, respectively) and a total of 532 452 incident patients with cancer (median age range 60 to 72 years across cancer types) from 1997 to 2015. Measurements: All-cause mortality. Methods: The survival of study participants was described using the Kaplan-Meier product limit estimator. The rate of survival was compared between kidney transplant recipients and patients with cancer using extended Cox regression with a Heaviside function. Results: Kidney transplant recipients had a higher survival probability compared with all cancer types. For example, male kidney transplant recipients had a 5-year survival probability of 89.6% (95% confidence interval [CI]: 88.6%-90.5%) compared with 83.3% (95% CI: 83.1%-83.5%) in patients with prostate cancer, and 14.0% (95% CI: 13.7%-14.3%), 56.1% (95% CI: 55.7%-56.5%), and 9.1% (95% CI: 8.5%-9.7%) in patients with lung, colorectal, and pancreas cancer, respectively. After presenting survival probabilities by age at cohort entry and after adjusting for clinical characteristics, similar results were found with a few exceptions. Unlike the unadjusted analysis, in the adjusted analysis males with prostate cancer had a significantly higher survival compared with kidney transplant recipients and females with breast cancer had higher survival compared with kidney transplant recipients at 2+ years of follow-up. In a subpopulation of the cohort who had information available on cancer stage (ie, stages 1-4), we generally found similar results to our primary analysis with kidney transplant recipients having a higher survival probability compared with each cancer stage. However, female kidney transplant recipients had a lower survival probability compared with females with stage 1 breast cancer, whereas male kidney transplant recipients had a lower survival probability compared with males with stage 1 to 3 prostate cancer. Limitations: External generalizability, residual confounding, and cancer stage could only be provided for a subpopulation. Conclusion: Mortality in kidney transplant recipients is lower than in patients with several cancer types. These results improve our understanding of the mortality burden in this population and reaffirm kidney transplantation as a good treatment option for end-stage kidney disease but also highlight the continuing need to improve posttransplant survival. Trial registration: This is not applicable as this is a population-based cohort study and not a clinical trial.

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

International Journal of Cancer ◽

10.1002/ijc.32585 ◽

2020 ◽

Vol 146 (10) ◽

pp. 2703-2711 ◽

Cited By ~ 4

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

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Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients: a population-based cohort study

Infectious Diseases ◽

10.1080/23744235.2016.1248483 ◽

2016 ◽

Vol 49 (4) ◽

pp. 286-295 ◽

Cited By ~ 4

Author(s):

Lars Skov Dalgaard ◽

Mette Nørgaard ◽

Johan Vestergaard Povlsen ◽

Orla Morrissey ◽

Bente Jespersen ◽

...

Keyword(s):

Cohort Study ◽

Kidney Transplant ◽

Population Based ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

First Time

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Survival After Cutaneous Melanoma in Kidney Transplant Recipients: A Population-Based Matched Cohort Study

American Journal of Transplantation ◽

10.1111/ajt.12716 ◽

2014 ◽

Vol 14 (6) ◽

pp. 1368-1375 ◽

Cited By ~ 27

Author(s):

C. M. Vajdic ◽

A. H. Chong ◽

P. J. Kelly ◽

N. S. Meagher ◽

M. T. Van Leeuwen ◽

...

Keyword(s):

Cohort Study ◽

Kidney Transplant ◽

Cutaneous Melanoma ◽

Population Based ◽

Matched Cohort ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Matched Cohort Study

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Risk Factors and Outcomes of Early Hospital Readmission in Canadian Kidney Transplant Recipients: A Population-Based Multi-Center Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211060926 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110609

Author(s):

Kyla L. Naylor ◽

Gregory A. Knoll ◽

Justin Slater ◽

Eric McArthur ◽

Amit X. Garg ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Kidney Transplant ◽

Hospital Readmission ◽

Graft Failure ◽

Population Based ◽

Income Quintile ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Increased Risk

Background: Early hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs. Objective: To determine risk factors and outcomes associated with EHRs (ie, hospitalization within 30 days of discharge from transplant hospitalization) in kidney transplant recipients. Design: Population-based cohort study using linked, administrative health care databases. Setting: Ontario, Canada. Patients: We included 5437 kidney transplant recipients from 2002 to 2015. Measurements: Risk factors and outcomes associated with EHRs. We assessed donor, recipient, and transplant risk factors. We also assessed the following outcomes: total graft failure, death-censored graft failure, death with a functioning graft, mortality, and late hospital readmission. Methods: We used multivariable logistic regression to examine the association of each risk factor and the odds of EHR. To examine the relationship between EHR status (yes vs no [reference]) and the outcomes associated with EHR (eg, total graft failure), we used a multivariable Cox proportional hazards model. Results: In all, 1128 kidney transplant recipients (20.7%) experienced an EHR. We found the following risk factors were associated with an increased risk of EHR: older recipient age, lower income quintile, several comorbidities, longer hospitalization for initial kidney transplant, and older donor age. After adjusting for clinical characteristics, compared to recipients without an EHR, recipients with an EHR had an increased risk of total graft failure (adjusted hazard ratio [aHR]: 1.46, 95% CI: 1.29, 1.65), death-censored graft failure (aHR: 1.62, 95% CI: 1.36, 1.94), death with graft function (aHR: 1.34, 95% CI: 1.13, 1.59), mortality (aHR: 1.41, 95% CI: 1.22, 1.63), and late hospital readmission in the first 0.5 years of follow-up (eg, 0 to <0.25 years: aHR: 2.11, 95% CI: 1.85, 2.40). Limitations: We were not able to identify which readmissions could have been preventable and there is a potential for residual confounding. Conclusions: Results can be used to identify kidney transplant recipients at risk of EHR and emphasize the need for interventions to reduce the risk of EHRs. Trial registration: This is not applicable as this is a population-based cohort study and not a clinical trial.

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