TRENDS OF PREEMPTIVE KIDNEY TRANSPLANTATION IN PATIENTS APPROACHING END-STAGE RENAL DISEASE STRATIFIED BY PRIMARY DISEASE IN THE UNITED STATES FROM 1985 AND 2019

E-Poster

Abstract Title

First Name *

Gabriel Nicolas

Last Name *

Contreras Martin

Co-author 1

Javier Pagan jpagan2@med.miami.edu University of Miami Transplantation Miami

Co-author 2

Nicolas Bustamante bustamante.c.nicolas@gmail.com Universidad de Ciencias Medicas Medicine San Jose

Co-author 3

Mariella Ortigosa-Goggins mariellaogoggins@med.miami.edu University of Miami Transplantation Miami

Co-author 4

Miguel Bandes mab816@med.miami.edu University of Miami Medicine Miami

Co-author 5

Tali Elfassy t.elfassy@med.miami.edu University of Miami Medicine Miami

Co-author 6

Laura Aponte Becerra laura.apontebecerra@yale.edu Yale university Medicine Miami

Co-author 7

Jair Munoz Mendoza jmmendoza@med.miami.edu University of Miami Medicine Miami

Co-author 8

Efren Chavez Morales eac64@med.miami.edu University of Miami Medicine Miami

Co-author 9

Yelena Drexler yrd6@med.miami.edu University of Miami Medicne Miami

Co-author 10

Warren Lee Kupin wkupin@med.miami.edu University of Miami Transplantation Miami

Co-author 11

David Roth d.roth@med.miami.edu University of Miami Transplantation Miami

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Preemptive kidney transplantation improves survival of patients approaching end-stage renal disease (ESRD); however, on average only 2.3% of incident ESRD patients undergo preemptive kidney transplantation. In this longitudinal study, we compare trends of preemptive kidney transplantation in ESRD patients, stratifying by their primary disease conducive to ESRD.

Methods

The study population includes 3,035,161 incident ESRD patients with adequate records in the United States Renal Data System, who received their first service, either preemptive kidney transplantation (n= 69,560) or dialysis (n= 2,965,601), in the United States between 1985 and 2019. Patients were stratified by their primary diagnosis of ESRD in 6 groups: polycystic kidney disease (PKD), glomerular diseases excluding lupus (GD), lupus (LU), diabetes mellitus (DM), hypertension (HTN), and other diseases (OD). We excluded patients with unknown primary diagnosis of ESRD and patients with incident age more than 100 years. Trends of preemptive kidney transplantation were assessed with the Cochran-Armitage test. Odds ratios of preemptive kidney transplantation were estimated with logistic regression models.

Results

Overall, 2.29% (69,560/3,035,161) patients received preemptive kidney transplantation: 13.55% (11,049/81,532) in the PKD group, 5.12% (14,640/285,996) in the GD group, 3.69% (1,234/33,415) in the LU group, 1.23% (17,048/1,384,873) in the DM group, 1.11% (9,726/874,779) in the HTN group, and 4.24% (15,863/374,566) in the OD group. Preemptive kidney transplant compared to dialysis patients were younger and of Caucasian ancestry. Trends of preemptive kidney transplantation increased in the PKD, GD and LU groups and decreased in the DM, HTN and OD groups during the 35 years of observation:Conclusions

Trends of preemptive kidney transplantation are increasing in PKD, GD and LU patients but only notably in PKD patients approaching ESRD, despite superior survival in patients starting with preemptive kidney transplantation compared to dialysis.

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