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Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan

Chen, Hsin-Hung1; Chern, Yahn-Bor2; Hsu, Chih-Yang1; Tang, Pei-Ling1; Lai, Chi-Cheng3

Research facility: Taiwan National Health Insurance Research Database
Published May 06, 2022; Updated May 10, 2022 on Dryad. https://doi.org/10.5061/dryad.rfj6q57d1

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May 06, 2022 version files 311.28 KB

Abstract

Objectives: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular events (CVEs), and kidney transplantation (KT) has been reported to improve risk of CVEs and survival. As the association of KT timing on long-term survival and clinical outcomes remains unclear, we investigated the association of different KT waiting times on clinical outcomes.

Design: Retrospective observational cohort study.

Setting: We conducted an observational cohort study using data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated kidney transplantation therapy from 1997 to 2013 were included.

Participants: A total of 3562 adult patients who initiated uncomplicated KT therapy were included and categorized into four groups according to KT waiting times after ESRD: Group 1 (<1 year), Group 2 (1–3 years), Group 3 (3–6 years), and Group 4 (>6 years).

Primary outcome measure: The main outcome was a composite of all-cause death, nonfatal myocardial infarction, or nonfatal stroke, based on the primary diagnosis in medical records during hospitalization.

Results: Compared with Group 1, the adjusted risk of primary outcome events (all-cause death, nonfatal myocardial infarction, or nonfatal stroke) increased by 1.67 times in Group 2 (95% CI: 1.40–2.00; P <0.001), 2.17 times in Group 3 (95% CI: 1.73–2.71; P <0.001), and 3.10 times in Group 4 (95% CI: 2.21–4.35; P <0.001). The rates of primary outcome events were 6.7%, 13.4%, and 14.0% within five years, increasing to 19.5%, 26.3%, and 30.8% within 10 years in Groups 1, 2, and 3, respectively.

Conclusions: Our results demonstrate that early KT is associated with superior long-term cardiovascular outcomes compared to late KT in selected ESRD patients receiving uncomplicated KT, suggesting that an early KT could be a better treatment option for ESRD patients who are eligible for transplantation.