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IS HIGHER CO-MORBIDITY THE EXPLANATION FOR THE INCREASED MORTALITY IN “NEVER TRANSPLANTED” WAITING LIST PATIENTS COMPARED TO RENAL TRANSPLANTED PATIENTS? Vibeke Rømming Sørensen, Department of Nephrology, Rigshospitalet James Heaf, Department of Nephrology, Herlev Hospital Søren Schwartz Sørensen, Department of Nephrology, Rigshospitalet

BACKGROUND Well known that the observed survival in transplanted patients is much better than in never transplanted patients on the waiting-list treated with dialysis Hovewer no randomized studies proving the benefit of renal transplantation exist 3

The number of available organs from deceased donors have not kept pace with the number of patients on the waiting list The fact that every year a number of patients die while waiting for a kidney is offen debated in the media Could these patients have been saved if more organs were available ? BACKGROUND 4

AIM Among patients on the waiting-list compared to transplanted patients to describe: co-morbidity mortality causes of dead 5

MATERIALS AND METHODS Data from Danish Nephrology Registry and the database Scandiatransplant were combined. Charlson Comorbidity Index (CCI) scores were derived from the National Danish Admissions Registry, which records all discharge diagnoses. Study period was:

SUBJECTS Patients were divided into 3 groups: 1.Waiting list group (WL) i.e. never transplanted 2.Transplanted with deceased donor (DDTx) 3.Transplanted with a living donor (LDTx). Only patients waiting for or receiving their first renal transplant were included. For the purposes of this study, withdrawal from the waiting list was not studied, since the data regarding this phenomenon is limited 7

WLDDTxLDTx N Sex (female %)38 ESRD age (yr)50.6 ±12 cC 44.8 ± ±15 WL age (yr)52.0 ±11 cC 45.9 ± ±15 Tx age (yr)47.5 ± ±16 Time from ESRD to WL (YR) 1.38 ±1.9 cC 1.02 ± ±1.2 Time from WL to RT (yr) 1.64 ± ±1.4 RESULTS WL vs. DDTx: a:p<0.05; b:p<0.01; c: p< WL vs. LDTx: A:p<0.05; B:p<0.01; C: p< DDTx vs. LDTx: : 1:p<0.05; 2:p<0.01; 3: p<

P<0.001 All patients automatically receive two CCI points because of end stage renal failure (ESRD) 9

WL versus DDTx: NS, WL versus LDTx: NS % 10

Cardiovascular death in among WL-patients, DDTx-patients and LDTx-patients WL versus DDTx p=0.09, WL versus LDTx p<

P <

Multivariate regression analysis Correction for age, sex, renal diagnosis, co- morbidity and cohort ( patients receiving a deceased donor transplant had a defined relative mortality risk of 1.) WL patientes: HR= 3,32 (2,81-3,82)p < LDTx patients: HR= 0,70 (0,56-0,87) p< 0.01

CONCLUSION Is higher co-morbidity the explanation for the increased mortality in “never transplanted” waiting list patients compared to renal transplanted patients ? YES, WL are older and have a significanty higher CCI score at ESRD and time of entering the waiting list NO, However when correction for this together with (age, sex, renal diagnosis and cohord) stil mortality 3 times higher in WL patients compared to DDTx patients Maybe, Having a high co-morbidity when entering the WL, even after going though the præ-transplantation programe, increases the risk of being in the ”never transplanted” group 14