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-2018 23:39:57 Link to item http://hdl.handle.net/10147/44657 Find this and similar works at - http://www.lenus.ie/hse
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.
Irish renal transplant registry 2462 renal transplants 14.03.66-16.01.01 15.7% more than 1 transplant Median age 20 in 1966-42 in 2000 Over 65s 0 in 1966-8 % in 2000 (2.2 % - 8 % in last decade) Male : Female ratio 64 : 36
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 - 1190) GN DM Inh(ADPKD) BP Depot Obstr Pyelo Misc Unknown
Irish renal transplant registry Transplantation increased in the first 2 decades but has levelled off since 1990 Mean - 136 transplants p.a. in last 15 years (range 114-158) 37.5 transplants per million population p.a. 2000 1998 1996 1994 1992 1990 1988 1986 0 50 100 150 200
Transplant Activity 2000 1500 1000 500 0 1986 1987 1988 Y 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 year The cumulative number of functioning grafts ( ) and transplants performed ( ) between 1986 and 2000
Prevalence of ESRD - International Comparisons 1600 1400 1200 1000 800 600 400 200 0 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
Transplantation Rates for Selected 50 45 40 35 30 25 20 15 10 5 0 37.5 Countries USA Ger Irl Den Can UK Aus Brz Pol Rom Jpn Renal Tx /million popn Ireland 1999, rest 1997
Percent of prevalent ESRD patients with 60 50 40 30 20 10 59% a functioning transplant 0 IRL Swe UK NL Aus NZ Den Bel Can Fra HK USA Ger CHL Urg Ireland 2000, rest 1997
Patients with a Functioning Transplant per million population, 1997 400 350 300 250 200 150 100 50 0 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
Aims Assess patient survival Study renal graft survival Comparison with international figures. Have these parameters improved with time? Identify risk factors
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: 1986-89, 90-94, 95-99
Results - 1 1659 transplants in 1490 patients Median age at first Transplant - 42 (2-76) Male : Female 64 : 36 Predicted time to failure - 10.5 yrs ( 95% C.I. 9.3-11.7 ) Median patient survival - 22.5 yrs ( 95% C.I. 18.6-26.1)
Patient survival
Graft survival
Results - Graft survival 87 87 16 14.1 86 14 85 84 12 9.8 84 83 82 81 80 81 10 8 6 4 9 79 2 78 86-89 90-94 95-99 1 year graft survival % 0 86-89 90-94 95-99 Graft 1/2 life in years
1, 3 & 5 year graft survival 90 80 70 63 68 75 60 50 40 30 1 year 3 year 5 year 20 10 0 86-89 90-94 95-99 Survival in %
International Comparisons 1 yr survival 1988 - % 1 yr survival 1996 - % Graft 1/2 life 1988 - yrs Graft 1/2 life 1996 - yrs UNOS - Ireland Hariharan et al* 75.7 81 87.7 87 7.9 9 13.8 14.1 * N Engl J Med 2000; 342(9): 605-612
Results - Risk factors Variable Hazard Ratio p value 95% C.I. Era of transplant 0.813.001 0.719-0.920 Recipient age 1.005.114 0.999-1.010 Recipient sex 1.036.557 0.879-1.269 PRA % 1.210.008 1.050-1.392 HLA missmatch 0.927.455 0.763-1.129 Transplant no. 1.280.004 1.015-1.615.(1 vs. 2 or more) CMV 1.793.000 1.358-2.368 Donor age 1.014.000 1.008-1.020 Donor sex 0.726.003 0.587-0.896
Multivariate analysis (cox proportional hazard) Variable Haz. Ratio P value 95% C.I. Era 1.54 0.004 1.14-2.07 CMV + 1.53 0.004 1.15-2.03 Donor sex 0.74 0.032 0.56-0.97 Donor age 1.02 0.000 1.01-1.03
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
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