TY - JOUR
T1 - Mortality and access to kidney transplantation in patients with sickle cell disease–associated kidney failure
AU - Bae, Sunjae
AU - Johnson, Morgan
AU - Massie, Allan B.
AU - Luo, Xun
AU - Haywood, Carlton
AU - Lanzkron, Sophie M.
AU - Grams, Morgan E.
AU - Segev, Dorry L.
AU - Purnell, Tanjala S.
N1 - Funding Information:
The authors were supported by an ASN Foundation for Kidney Research Pre-Doctoral Fellowship Award (principal investigator [PI]: S. Bae); Agency for Healthcare Research and Quality grant K01HS024600 (PI: T.S. Purnell); National Institute of Diabetes and Digestive and Kidney Diseases grants K01DK101677 (PI: A. Massie), K08DK092287 (PI: M.E. Grams); National Institute of Allergy and Infectious Diseases grant K24AI44954 (PI: D. Segev); National Heart, Lung, and Blood Institute grant K01HL108832 (PI: C. Haywood); and a Patient-Centered Outcomes Research Institute research project grant (PI: S. Lanzkron).The funders had no role in the design and conduct of the study, interpretation of data, or preparation of the manuscript. The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The data reported here have been supplied by the Hennepin Healthcare Research Institute as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. Dr. Sunjae Bae and Dr. Tanjala S. Purnell had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; Dr. Sunjae Bae, Dr. Morgan Johnson, Dr. Allan B. Massie, Dr. Xun Luo, Dr. Dorry L. Segev, and Dr. Tanjala S. Purnell were responsible for study concept and design; Dr. Sunjae Bae, Dr. Allan B. Massie, Dr. Xun Luo, Dr. Carlton Haywood, Dr. Sophie M. Lanzkron, Dr. Morgan E. Grams, and Dr. Tanjala S. Purnell were responsible for acquisition, analysis, or interpretation of data; Dr. Sunjae Bae, Dr. Morgan Johnson, Dr. Dorry L. Segev, and Dr. Tanjala S. Purnell were responsible for drafting the manuscript; Dr. Sunjae Bae and Dr. Xun Luo were responsible for statistical analysis; Dr. Dorry L. Segev and Dr. Tanjala S. Purnell supervised the study; and all authors were responsible for critical revision of the manuscript for important intellectual content.
Publisher Copyright:
© 2021 by the American Society of Nephrology.
PY - 2021/3
Y1 - 2021/3
N2 - Background and objectives Patients with sickle cell disease–associated kidney failure have high mortality, which might be lowered by kidney transplantation. However, because they show higher post-transplant mortality compared with patients with other kidney failure etiologies, kidney transplantation remains controversial in this population, potentially limiting their chance of receiving transplantation. We aimed to quantify the decrease in mortality associated with transplantation in this population and determine the chance of receiving transplantation with sickle cell disease as the cause of kidney failure as compared with other etiologies of kidney failure. Design, setting, participants, & measurements Using a national registry, we studied all adults with kidney failure who began maintenance dialysis or were added to the kidney transplant waiting list in 1998–2017. To quantify the decrease in mortality associated with transplantation, we measured the absolute risk difference and hazard ratio for mortality in matched pairs of transplant recipients versus waitlisted candidates in the sickle cell and control groups. To compare the chance of receiving transplantation, we estimated hazard ratios for receiving transplantation in the sickle cell and control groups, treating death as a competing risk. Results Compared with their matched waitlisted candidates, 189 transplant recipients with sickle cell disease and 220,251 control recipients showed significantly lower mortality. The absolute risk difference at 10 years post-transplant was 20.3 (98.75% confidence interval, 0.9 to 39.8) and 19.8 (98.75% confidence interval, 19.2 to 20.4) percentage points in the sickle cell and control groups, respectively. The hazard ratio was also similar in the sickle cell (0.57; 95% confidence interval, 0.36 to 0.91) and control (0.54; 95% confidence interval, 0.53 to 0.55) groups (interaction P=0.8). Nonetheless, the sickle cell group was less likely to receive transplantation than the controls (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.61 to 0.87). Similar disparities were found among waitlisted candidates (subdistribution hazard ratio, 0.62; 95% confidence interval, 0.53 to 0.72). Conclusions Patients with sickle cell disease–associated kidney failure exhibited similar decreases in mortality associated with kidney transplantation as compared with those with other kidney failure etiologies. Nonetheless, the sickle cell population was less likely to receive transplantation, even after waitlist registration.
AB - Background and objectives Patients with sickle cell disease–associated kidney failure have high mortality, which might be lowered by kidney transplantation. However, because they show higher post-transplant mortality compared with patients with other kidney failure etiologies, kidney transplantation remains controversial in this population, potentially limiting their chance of receiving transplantation. We aimed to quantify the decrease in mortality associated with transplantation in this population and determine the chance of receiving transplantation with sickle cell disease as the cause of kidney failure as compared with other etiologies of kidney failure. Design, setting, participants, & measurements Using a national registry, we studied all adults with kidney failure who began maintenance dialysis or were added to the kidney transplant waiting list in 1998–2017. To quantify the decrease in mortality associated with transplantation, we measured the absolute risk difference and hazard ratio for mortality in matched pairs of transplant recipients versus waitlisted candidates in the sickle cell and control groups. To compare the chance of receiving transplantation, we estimated hazard ratios for receiving transplantation in the sickle cell and control groups, treating death as a competing risk. Results Compared with their matched waitlisted candidates, 189 transplant recipients with sickle cell disease and 220,251 control recipients showed significantly lower mortality. The absolute risk difference at 10 years post-transplant was 20.3 (98.75% confidence interval, 0.9 to 39.8) and 19.8 (98.75% confidence interval, 19.2 to 20.4) percentage points in the sickle cell and control groups, respectively. The hazard ratio was also similar in the sickle cell (0.57; 95% confidence interval, 0.36 to 0.91) and control (0.54; 95% confidence interval, 0.53 to 0.55) groups (interaction P=0.8). Nonetheless, the sickle cell group was less likely to receive transplantation than the controls (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.61 to 0.87). Similar disparities were found among waitlisted candidates (subdistribution hazard ratio, 0.62; 95% confidence interval, 0.53 to 0.72). Conclusions Patients with sickle cell disease–associated kidney failure exhibited similar decreases in mortality associated with kidney transplantation as compared with those with other kidney failure etiologies. Nonetheless, the sickle cell population was less likely to receive transplantation, even after waitlist registration.
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U2 - 10.2215/CJN.02720320
DO - 10.2215/CJN.02720320
M3 - Article
C2 - 33632759
AN - SCOPUS:85102473588
SN - 1555-9041
VL - 16
SP - 407
EP - 414
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 3
ER -