The Irish Renal Transplant Registry: recipient demographics and outcomes / K.A. Abraham... [et al.]

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1 The Irish Renal Transplant Registry: recipient demographics and outcomes / K.A. Abraham... [et al.] Item type Authors Rights Presentation Abraham, K A Beaumont Hospital Downloaded 10-Jul :39:57 Link to item Find this and similar works at -

2 The Irish renal transplant registry; recipient demographics and outcomes. K.A. Abraham, P. O'Kelly, K. Tyrrell, V. Frances,E Dunne, P. Cunningham, S. Spencer, D. Hickey, J.J. Walshe, P.J. Conlon on behalf of the National Renal Transplant Registry, Beaumont Hospital, Dublin 9.

3 Irish renal transplant registry 2462 renal transplants % more than 1 transplant Median age 20 in in 2000 Over 65s 0 in % in 2000 (2.2 % - 8 % in last decade) Male : Female ratio 64 : 36

4 Causes of ESRD 10% 7% 15% 39% 6% 14% 7% Prevalence of Dialysis - 226/ million Prevalence of Transplantation - 323/ million Prevalence of ESRD - 550/ million (US ) GN DM Inh(ADPKD) BP Depot Obstr Pyelo Misc Unknown

5 Irish renal transplant registry Transplantation increased in the first 2 decades but has levelled off since 1990 Mean transplants p.a. in last 15 years (range ) 37.5 transplants per million population p.a

6 Transplant Activity Y year The cumulative number of functioning grafts ( ) and transplants performed ( ) between 1986 and 2000

7 Prevalence of ESRD - International Comparisons Jpn US Italy Ger Swe Fra 550 Irl Aus UK Isr Pol Jpn US Italy Ger Swe Fra Irl Aus UK Isr Pol Ireland 2000, rest 1998

8 Transplantation Rates for Selected Countries USA Ger Irl Den Can UK Aus Brz Pol Rom Jpn Renal Tx /million popn Ireland 1999, rest 1997

9 Percent of prevalent ESRD patients with % a functioning transplant 0 IRL Swe UK NL Aus NZ Den Bel Can Fra HK USA Ger CHL Urg Ireland 2000, rest 1997

10 Patients with a Functioning Transplant per million population, IRL* SWE UK NL AUS NZ DEN* BEL CAN FRA* HK* POL USA BRZ GER* ITA* CHL Functioning Transplants/Million Pop URG *Data are from 1996 Country

11 Aims Assess patient survival Study renal graft survival Comparison with international figures. Have these parameters improved with time? Identify risk factors

12 Methods Created a data bank from various sources All transplant recipients between 1986 and 1999 followed till death or failure of latest graft Cox proportional hazards model and Kaplan-Meier survival curves JMP & Stata statistical programmes Eras for comparison: , 90-94, 95-99

13 Results transplants in 1490 patients Median age at first Transplant - 42 (2-76) Male : Female 64 : 36 Predicted time to failure yrs ( 95% C.I ) Median patient survival yrs ( 95% C.I )

14 Patient survival

15 Graft survival

16 Results - Graft survival year graft survival % Graft 1/2 life in years

17 1, 3 & 5 year graft survival year 3 year 5 year Survival in %

18 International Comparisons 1 yr survival % 1 yr survival % Graft 1/2 life yrs Graft 1/2 life yrs UNOS - Ireland Hariharan et al* * N Engl J Med 2000; 342(9):

19 Results - Risk factors Variable Hazard Ratio p value 95% C.I. Era of transplant Recipient age Recipient sex PRA % HLA missmatch Transplant no (1 vs. 2 or more) CMV Donor age Donor sex

20 Multivariate analysis (cox proportional hazard) Variable Haz. Ratio P value 95% C.I. Era CMV Donor sex Donor age

21 Summary Short & long term improvement in graft survival Patient survival uniform in the 3 eras PRA, Transplant no., CMV +, - risk factors Donor factors- younger age, male sex - predict improved graft survival

22 Acknowledgements Nephrologists Transplant surgeons Laboratory Support B.O Dwyer A. Walsh G. Doyle M. Carmody S. Hanson A. Dorman J.J. Walshe P. McLean M. Keoghan J. Donohoe D. Murphy All staff in Tissue P.J. Conlon D.P. Hickey Typing Dept. J.A.B. Keogh M. Donovan A. Watson T. Creagh All doctors and nurses G. Mellotte D. Little on the renal and H.R. Brady Transplant Coordinators transplant teams Y. O Meara P. Cunningham D. Gill A. Counihan We gratefully P. Deasy L. Hacke acknowledge the D. Murnaghan K. Tyrrell financial support B. Duffy Outcome Research Centre received from the C. Cronin P. Kelly Transplant Foundation F. Walker S. Spencer and Novartis -- V. Frances, E. Dunne Pharmaceuticals