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.

The data for this study were collected from patients who initiated kidney transplantation therapy from 1997 to 2013 were enrolled in the National Health Insurance Research Database (NHIRD) in Taiwan.

A total of 3,562 eligible ESRD adults receiving uncomplicated KT between January 1997 and December 2012 were selected.