Comparison of survival for haemodialysis patients vs renal transplant recipients treated in Uruguay

Mazzuchi, Nelson; González-Martínez, Francisco; Carbonell, Enriqueta; Curi, L; Fernández‐Cean, Juan; Orihuela, Sergio

doi:10.1093/ndt/14.12.2849

Cited by 18 publications

(14 citation statements)

References 19 publications

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“…Thus, several studies have examined this question among non-indigenous groups using both registries and single-centre data. 2,3,[9][10][11][12][13][14] The major concerns with using observational studies to answer this question are those of selection bias and lead-time bias. Some of these studies address this by restricting the comparisons to deceased donor recipients versus those waiting for a deceased donor thereby eliminating the selection bias associated with process of assessment of fitness for renal transplantation.…”

Section: Is There a Survival Advantage To Transplant Recipients?mentioning

confidence: 99%

Indigenous transplant outcomes in Australia: What the ANZDATA Registry tells us

McDonald

2004

Nephrology

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While the rates of renal replacement therapy for end-stage renal disease (ESRD) among Aboriginal Australians have increased rapidly over the past 20 years, the chances of Aboriginal Australians receiving a kidney transplant are about one-third those among non-Aboriginal Australians. The lower percentage of transplants from living donors for Aboriginal recipients (14%) compared with non-Aboriginal Australians (36%) since 1997 contributes to this. Furthermore, among recipients of grafts from cadaveric donors, waiting times are longer, the number of human leucocyte antigen mismatches is significantly greater among Aboriginal (4.11 (95% confidence interval 3.83-4.39)) vs non-Aboriginal recipients (2.95 (95% CI 2.87-3.02); P <0.001), and sensitised recipients are more common (peak panel reactive antibody > or = 50%, 25% among Aboriginal vs 12% among non-Aboriginal recipients (P <0.001). Graft survival is poorer amongst Aboriginal Australians than non-Aboriginal Australians - independent of whether the graft is from a living donor or deceased donor. Among primary deceased donor graft recipients, the hazard ratio (HR) for graft survival among Aboriginal recipients was 3.1 (95% CI 2.2-4.2), P<0.001 and that for patient survival 3.6 (95% CI 2.5-5.1, P <0.001) compared with non-Aboriginal Australians. This higher graft-loss rate among Aboriginal recipients of primary deceased donor grafts persists even after adjustment for the higher rate of comorbidity in this group (HR of 1.95 (1.22-3.11, P=0.005). This is reflected in higher rates of vascular rejection among Aboriginal recipients, with a crude relative risk of 1.97 (95% CI 1.63-2.34) (P <0.001), compared with non-Aboriginal Australians. Despite the advantages in terms of morbidity and quality of life, it remains uncertain whether transplantation offers a mortality advantage among Aboriginal Australians.

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Section: Is There a Survival Advantage To Transplant Recipients?mentioning

confidence: 99%

Indigenous transplant outcomes in Australia: What the ANZDATA Registry tells us

McDonald

2004

Nephrology

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“…Mazzuchi et al 13 , no Uruguai, analisaram a sobrevida de pacientes em hemodiálise e de pacientes transplantados. Ao fim, no grupo de pacientes não diabéticos, não se encontrou diferença no tempo de sobrevida entre as duas modalidades de tratamento quando ajustado por fatores de co-morbidade.…”

Section: Introductionunclassified

Tempo até o transplante e sobrevida em pacientes com insuficiência renal crônica no Estado do Rio de Janeiro, Brasil, 1998-2002

et al. 2007

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Neste estudo, descreveram-se as características dos 14.419 pacientes com insuficiência renal crônica tratados por hemodiálise no Estado do Rio de Janeiro, Brasil, e analisou-se o tempo até a primeira realização do transplante no período de 1998 a 2002. Técnicas de análise de sobrevida como a análise não paramétrica de Kaplan-Meier e a modelagem semiparamétrica com o modelo de riscos proporcionais de Cox foram utilizadas. Além do modelo de sobrevida para transplante, o tempo até o óbito foi estimado para a comparação das estimativas dos dois modelos. Os resultados mostraram que, no período estudado, apenas 6,3% dos pacientes foram transplantados, 32,4% foram indicados e 6,3% inscritos na lista de espera. Observa-se que a probabilidade de transplante dos pacientes indicados, inscritos para o transplante e os que estão em uma faixa etária reduzida é maior. A diabetes mellitus possui um efeito redutor de 35% no risco de realização de transplante. Todas as estimativas apresentaram direções contrárias às obtidas pelo modelo de sobrevida para óbito.

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“…Mazzuchi et al 5 showed 1-, 5-, and 10-year survival rates of 95.2%, 88%, and 78.8% for renal transplantation patients versus 90.6%, 62.7%, and 39.8% for patients on long-term renal dialysis. 4 Unfortunately, the demand for donor organs has greatly exceeded the supply, and according to the United Network for Organ Sharing, between 1998 and 2008 the number of people in the United States awaiting kidney transplantation doubled, from 40,000 to 80,000. In an effort to expand the donor pool, many transplant centers have implemented additional strategies such as laparoscopic donor nephrectomy for living donors, use of nonheart-beating donors, and acceptance of organs from suboptimal donors (ECDs).…”

Section: Discussionmentioning

confidence: 99%

Frozen Section Evaluation of Preimplantation Donor Kidneys

Huebner

Papadimitriou

Gonzalez

et al. 2010

Pathology Case Reviews

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The benefits of renal transplantation for patients with endstage renal disease on hemodialysis are well established, but currently there is a significant shortage of organs available for transplantation. In an effort to increase the size of the donor pool, donors that may have been excluded from donating previously are currently accepted. Frozen section evaluation of preimplantation donor kidney biopsies is particularly important for organs from these expanded criteria donors, both to determine organ suitability and as a tool to predict short-and long-term graft survival. Although significant progress has been made in the field, controversy still remains regarding the predictive value of the individual pathologic parameters to predict graft outcome. The Maryland Aggregate Pathology Index score is based on the identification of 5 histologic parameters and is used to stratify donor organs into low-, intermediate-, and high-risk groups, which correlate with overall graft survival. Irrespectively of the transplant donor population, preimplantation donor kidney frozen section evaluation is an invaluable tool for optimal use of the available organs.A 62-year-old white woman with a 15-year history of type 2 diabetes mellitus, obesity, and hypertension was admitted for an ischemic cerebral stroke and ultimately died despite appropriate medical treatment. After discussion with the family, it became clear that the patient wished to be an organ donor, and both kidneys were harvested for further evaluation. During the course of the disease, the patient had a good renal function with a terminal serum creatinine level of 1.5 mg/dL. On the basis of the clinical information, the patient was categorized as an expanded criteria donor (ECD; refer to the next sections). Pathologic EvaluationWedge biopsies of each kidney were submitted for frozen section preimplantation analysis. The biopsies measured a mean of 1.4 Â 0.8 Â 0.4 cm. The specimens were blotted dry and snap frozen in liquid nitrogen. Routinely prepared 5-Km-thick sections, stained with hematoxylin and eosin, were evaluated.Global evaluation of the frozen sections at low magnification demonstrated preserved renal cortex with an adequate number of glomeruli (mean, 62 per section). Similar findings were observed in the left and right kidneys, with global glomerular sclerosis of 17% and 20%, respectively. There were small scattered areas of tubulointerstitial atrophy (scarring) that affected up to 15% of the overall cortical surface.Two to 4 interlobular arteries were present in each section, and in the most affected arteries, there was moderate narrowing due to arteriosclerosis (wall-to-lumen ratios [WLRs], Q0.5). Many arterioles (glomerular-size, preglomerular) had thickening of their walls due to hyalinosis.

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Comparison of survival for haemodialysis patients vs renal transplant recipients treated in Uruguay

Abstract: We conclude that when the outcome is adjusted to co-morbid factors there is no difference between renal transplant recipients and haemodialysis patients survival in non-diabetic patients, while renal transplantation gives better survival rates than haemodialysis in diabetic patients.

Cited by 18 publications

References 19 publications

Indigenous transplant outcomes in Australia: What the ANZDATA Registry tells us

Indigenous transplant outcomes in Australia: What the ANZDATA Registry tells us

Tempo até o transplante e sobrevida em pacientes com insuficiência renal crônica no Estado do Rio de Janeiro, Brasil, 1998-2002

Frozen Section Evaluation of Preimplantation Donor Kidneys

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