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Patient and Kidney Allograft Survival in Recipients With End-Stage Renal Disease From Amyloidosis

Sawinski, Deirdre MD1; Lim, Mary Ann MD1; Cohen, Jordana B. MD, MSCE1,2; Locke, Jayme E. MD, MPH3; Weiss, Brendan MD4,5; Hogan, Jonathan J. MD1,4; Dember, Laura M. MD1,2,4

doi: 10.1097/TP.0000000000001930
Original Clinical Science—General

Background Outcomes after kidney transplantation for patients with amyloidosis-associated end-stage renal disease (ESRD) have not been well characterized.

Methods We performed a retrospective propensity score matched cohort study with Cox proportional hazards modeling using data from the United Network of Organ Sharing including patients transplanted from 1987 to 2015 (N = 310 629).

Results Amyloidosis patients (N = 576) had higher rates of death (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.28-1.95) and graft loss (HR, 1.49; 95% CI, 1.19-1.87) compared with nonamyloidosis patients. The results were similar when the cohort was restricted to patients transplanted on or after 2001 (HR, 1.72; 95% CI, 1.31-2.26 for death; HR, 1.77; 95% CI, 1.35-2.33 for graft loss). However, there was no significant difference in risk of death or graft loss when amyloidosis patients were compared with those with diabetes-associated ESRD (mortality: HR, 0.99; 95% CI, 0.84-1.17; allograft loss: HR, 1.00; 95% CI, 0.84-1.20), or when compared with elderly patients (age, >65 years at the time of transplant) (mortality: HR, 0.99; 95% CI, 0.81-1.21; graft loss: HR, 1.02; 95% CI, 0.82-1.26).

Conclusions For patients with amyloidosis-associated ESRD deemed suitable for transplantation, patient and graft survivals are diminished compared to kidney transplant recipients overall, but are comparable to other high-risk subgroups.

This retrospective analysis of UNOS data of patients transplanted from 1987-2015 (28 years) with a diagnosis of amyloidosis shows that although the risk of death or graft loss is higher than the general transplant population it is similar to that of diabetics. Supplemental digital content is available in the text.

1 Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

2 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

3 Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.

4 Penn Amyloidosis Program, Division of Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.

5 Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA.

Received 31 March 2017. Revision received 7 August 2017.

Accepted 13 August 2017.

The authors declare no funding or conflicts of interest.

D.S. participated in the study design; data acquisition, analysis and interpretation, and article draft and revision. M.A.L. participated in the study concept and design; data interpretation, and article draft and revision. J.C.C. participated in the study design, data acquisition, analysis and interpretation, and article revision. J.E.L. participated in the data interpretation and article revision. B.W. participated in the study concept and design, data interpretation, article revision. J.J.H. participated in the study concept and design, data interpretation, and article revision. L.M.D. participated in the study concept and design, data interpretation, and article revision.

Correspondence: Mary Ann Lim, MD, 3400 Spruce Street, Philadelphia PA 19104. (Maryann.lim@uphs.upenn.edu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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