A comparison of the effects of dialysis and renal transplantation on the survival of older uremic patients

Johnson, D. W., Herzig, K., Purdie, D., Brown, A. M., Rigby, R. J., Nicol, D. L. and Hawley, C. M. (2000) A comparison of the effects of dialysis and renal transplantation on the survival of older uremic patients. Transplantation, 69 5: 794-799.

Author Johnson, D. W.
Herzig, K.
Purdie, D.
Brown, A. M.
Rigby, R. J.
Nicol, D. L.
Hawley, C. M.
Title A comparison of the effects of dialysis and renal transplantation on the survival of older uremic patients
Journal name Transplantation   Check publisher's open access policy
ISSN 0041-1337
Publication date 2000
Sub-type Article (original research)
Volume 69
Issue 5
Start page 794
End page 799
Total pages 6
Place of publication Philadelphia
Publisher Lippincott Williams & Wilkins
Collection year 2000
Language eng
Subject C1
321029 Surgery
730109 Surgical methods and procedures
Abstract Background. Patients over age 60 constitute half of all new patients accepted into the renal replacement therapy programs in Australia. However, the optimal treatment of their end-stage renal disease remains controversial. The aim of the present study was to compare survival for dialysis and renal transplantation in older patients who were rigorously screened and considered eligible for transplantation. Methods. The study cohort consisted of 174 consecutive patients over 60 who were accepted on to the Queensland cadaveric renal transplant waiting list between January 1, 1993 and December 31, 1997, Follow-up was terminated on October 1, 1998, Data were analyzed on an intention-to-transplant basis using a Cox regression model with time-varying explanatory variables. An alternative survival analysis was also performed, in which patients no longer considered suitable for transplantation were censored at the time of their removal from the waiting list. Results. There were 67 patients receiving a renal transplant, whereas the other 107 continued to undergo dialysis, These two groups were well matched at baseline with respect to age, gender, body mass index, renal disease etiology, comorbid illnesses, and dialysis duration and modality. The overall mortality rate was 0.096 per patient-year (0.131 for dialysis and 0.029 for transplant, P<0.001), Respective 1-, 3- and B-year survivals were 92%, 62%, and 27% for the dialysis group and 98%, 95%, and 90% (P<0.01) for the transplant group. Patients in the transplant group had an adjusted hazard ratio 0.16 times that of the dialysis group (95% confidence interval 0.06 - 0.42), If patients were censored at the time of their withdrawal from the transplant waiting list, the adjusted hazard ratio was 0.24 (95% confidence interval 0.09 - 0.69), Conclusions. Renal transplantation seems to confer a substantial survival advantage over dialysis in patients with end-stage renal failure who are rigorously screened and considered suitable for renal transplantation.
Keyword Immunology
Surgery
Transplantation
65 Years Old
Kidney-transplantation
Elderly Patients
Replacement Therapy
Age
Recipients
Life
Cyclosporine
Experience
Disease
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Population Health Publications
School of Medicine Publications
 
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