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CMAJ • July 23, 2002; 167 (2)
© 2002 Canadian Medical Association or its licensors

Research
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Trends in mortality and graft failure for renal transplant patients

Douglas E. Schaubel*, John R. Jeffery{dagger}, Yang Mao{ddagger}, Robert Semenciw{ddagger}, Karen Yeates§ and Stanley S.A. Fenton§

From *the Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; {dagger}the Section of Nephrology, University of Manitoba, Winnipeg, Man.; {ddagger}the Surveillance and Risk Assessment Program, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa, Ont.; §the Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ont.; and ¶the Faculty of Medicine, University of Toronto, Toronto, Ont.

Correspondence to: Dr. Stanley S.A. Fenton, Toronto General Hospital, Division of Nephrology, 200 Elizabeth St., Rm. 232, 13th floor, Eaton Wing North, Toronto ON M5G 2C4; fax 416 340-4999; stanley.fenton{at}uhn.on.ca

Methods: We analyzed the rates of death and graft failure among the 11 482 Canadians with end-stage renal disease who received a kidney transplant in 1981–98. Patients were followed from the date of transplantation to the date of graft failure, the date of death or the end of the observation period, namely, Dec. 31, 1998, depending on which was the earliest. Rate ratios for mortality and graft failure — ratios of the rate for each calendar period to the rate for the arbitrarily chosen reference period, 1981–85 — were estimated with a piece-wise exponential model that adjusted for age, sex, ethnicity, primary renal diagnosis, follow-up time and donor-organ source.

Results: The rates and adjusted rate ratios for death and graft failure decreased significantly and steadily over time. Relative to 1981–85, the adjusted mortality rate ratios were 0.70 (95% confidence interval [CI] 0.54–0.89), 0.65 (95% CI 0.52–0.82) and 0.53 (95% CI 0.41–0.67) for 1986–89, 1990–94 and 1995–98 respectively, and the adjusted graft failure rate ratios were 0.68 (95% CI 0.60–0.78), 0.62 (95% CI 0.54–0.70) and 0.51 (95% CI 0.44–0.58) respectively. The decrease was mostly among the cadaveric-organ recipients. Calendar period was as important a predictor of outcome as well-known prognostic factors such as age and primary renal diagnosis.

Interpretation: Decreases in mortality rates are probably related to refinements in patient management. Decreases in graft failure rates are probably the result of a combination of improved immunotherapy and better management of nonimmunologic conditions such as hypertension and hyperlipidemia.




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 Nephrol Dial TransplantHome page
P. S. Rao, D. E. Schaubel, and R. Saran
Impact of graft failure on patient survival on dialysis: a comparison of transplant-naive and post-graft failure mortality rates
Nephrol. Dial. Transplant., February 1, 2005; 20(2): 387 - 391.
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