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Am J Transplant. 2018 Aug;18(8):1914-1923. doi: 10.1111/ajt.14694. Epub 2018 Mar 24.

Kidney transplant graft outcomes in 379 257 recipients on 3 continents.

Author information

1
Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
2
University of Michigan, Ann Arbor, MI, USA.
3
National Health Service Blood and Transplant, Bristol, UK.
4
Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, Australia.
5
University of Adelaide, Adelaide, Australia.

Abstract

Kidney transplant outcomes that vary by program or geopolitical unit may result from variability in practice patterns or health care delivery systems. In this collaborative study, we compared kidney graft outcomes among 4 countries (United States, United Kingdom, Australia, and New Zealand) on 3 continents. We analyzed transplant and follow-up registry data from 1988-2014 for 379 257 recipients of first kidney-only transplants using Cox regression. Compared to the United States, 1-year adjusted graft failure risk was significantly higher in the United Kingdom (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.18-1.26, P < .001) and New Zealand (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.14-1.46, P < .001), but lower in Australia (HR 0.90, 95% CI 0.84-0.96, P = .001). In contrast, long-term adjusted graft failure risk (conditional on 1-year function) was significantly higher in the United States compared to Australia, New Zealand, and the United Kingdom (HR 0.74, 0.75, and 0.74, respectively; each P < .001). Thus long-term kidney graft outcomes are approximately 25% worse in the United States than in 3 other countries with well-developed kidney transplant systems. Case mix differences and residual confounding from unmeasured factors were found to be unlikely explanations. These findings suggest that identification of potentially modifiable country-specific differences in care delivery and/or practice patterns should be sought.

KEYWORDS:

Scientific Registry of Transplant Recipients (SRTR); clinical research/practice; graft survival; kidney disease; kidney transplantation/nephrology; rejection

PMID:
29573328
DOI:
10.1111/ajt.14694

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