Analysis of mortality while on waiting list for kidney transplant in adults in Argentina 2005-2009

INTRODUCTION

Comparison of survival after renal transplant patients on the waiting list is an important factor to evaluate this therapy.

OBJECTIVE

To measure the magnitude of deceased donor kidney transplant on patient survival compared to patients on dialysis and on waiting lists in over 18 years in Argentina.

MATERIAL AND METHODS

The information was obtained from SINTRA for the period January 2003 to December 2009. The follow-up period ended in December 2010. Survival was considered as the time from the entrance to the waiting list until death, the end of the study (June 2009), or last follow-up available, whichever came first. The Kaplan-Meir method was used. The survival rate was recorded at 30 days, 1, 5 and 10 years. Log-rank was used to compare the curves and their statistical significance. The Cox regression model was used to consider the variables for both patient and graft survival, such as gender and age, time on dialysis, etiology of end-stage renal disease (ESRD), and presence of comorbidities. The MedCalc and SPSS 17 statistical packages were used.

RESULTS

We analyzed 1682 patients transplanted average age 48.14 + 13.48 years and 3647 patients on waiting lists average age 47.88 + 14.32 years. For patients transplanted 30-day survival was 99.8% at 1 year 96.2% and 5 years of 79.9%. For patients on the waiting list survival at 30 days was 99.7% at 1 year and 5 years 94.6% 66.6%. Chi-square was 42.77, P = <.0001. HR 0.64 (95% CI 0.56 to 0.73). Cox regression for patients on waiting lists HR 1.40 (95% CI 1.20-1.63) P = <.0001. The time dependent Cox regression showed for patients transplanted at 30 days, <1 year >1 year showed HR 4.18 (95% CI 2.88-6.06) P = <.0001, HR 0.40 (95% CI 0.27 to 0.61) P = <.0001 and HR 0.19 (95% CI 1.12-0.29) P = <.0001, respectively.

CONCLUSIONS

Survival, both at baseline and in the long term, is better in transplant patients as compared to patients on waiting list. In Cox time-dependant regression the risk of death during the first 30 days is 4 times higher in transplant patients. This reverses and at 1 year, transplant patients are 60% less likely to die, and after one year this probability is 81% lower (P =<.0001).

Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

BACKGROUND

In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL).

METHODS

Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL.

RESULTS

The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001).

CONCLUSIONS

After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.

Is fibrin glue useful in preventing dialysate leakage in children on CAPD? Preliminary results of a prospective randomized study

Children on continuous ambulatory peritoneal dialysis (CAPD) have a higher incidence of dialysate leakage than patients receiving cycler dialysis. To date, fibrin glue has been used to treat dialysate leakage but not as a method of prevention. Therefore, we conducted a prospective study in which 20 catheters were implanted in 19 children, with each catheter randomly assigned to either the treatment group (1 mL of fibrin glue added to peritoneal cuff suture) or the control group. There was no difference in mean patient age, elapsed time between catheter implantation and first catheter usage, and albumin concentration between the two groups. Dialysate leakage was detected in 4 patients in the control group, 3 of whom underwent early initiation of dialysis, but none of the patients in the treatment group (including 4 with early dialysis) had a similar problem. In summary, these preliminary data suggest that fibrin glue may be of benefit when applied at the time of catheter implantation. Further experience is necessary before this method can be routinely recommended.