Journal article
Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit
Transplantation direct, Vol.6(9), pp.e599-e599
09/01/2020
DOI: 10.1097/TXD.0000000000001043
PMCID: PMC7447442
PMID: 32903964
Abstract
Background. The impact of functional status on survival among simultaneous pancreas-kidney transplant (SPKT) candidates and recipients is not well described. Methods. We examined national Scientific Registry of Transplant Recipients (SRTR) data for patients listed for SPKT in the United States (2006-2019). Functional status was categorized by center-reported Karnofsky Performance Score (KPS). We used Cox regression to quantify associations of KPS at listing and transplant with subsequent patient survival, adjusted for baseline patient and transplant factors (adjusted hazard ratio,(95% LCL)aHR(95%UCL)). We also explored time-dependent associations of SPKT with survival risk after listing compared with continued waiting in each functional status group. Results. KPS distributions among candidates (N = 16 822) and recipients (N = 10 316), respectively, were normal (KPS 80-100), 62.0% and 57.8%; capable of self-care (KPS 70), 23.5% and 24.7%; requires assistance (KPS 50-60), 12.4% and 14.2%; and disabled (KPS 10-40), 2.1% and 3.3%. There was a graded increase in mortality after listing and after transplant with lower functional levels. Compared with normal functioning, mortality after SPKT rose progressively for patients capable of self-care (aHR,(1.00)1.18(1.41)), requiring assistance (aHR,(1.06)1.31(1.60)), and disabled (aHR,(1.10)1.55(2.19)). In time-dependent regression, compared with waiting, SPKT was associated with 2-fold mortality risk within 30 days of transplant. However, beyond 30 days, SPKT was associated with reduced mortality, from 52% for disabled patients (aHR,(0.26)0.48(0.88)) to 70% for patients with normal functioning (aHR,(0.26)0.30(0.34)). Conclusions. While lower functional status is associated with increased mortality risk among SPKT candidates and recipients, SPKT can provide long-term survival benefit across functional status levels in those selected for transplant.
Details
- Title: Subtitle
- Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit
- Creators
- Krista L. Lentine - St Louis Univ, Ctr Abdominal Transplantat, St Louis, MO 63103 USATarek Alhamad - Washington University in St. LouisWisit Cheungpasitporn - University of Mississippi Medical CenterJane C. Tan - Stanford UniversitySu-Hsin Chang - Washington University in St. LouisMatthew Cooper - MedStar Georgetown University HospitalDarshana M. Dadhania - NewYork–Presbyterian HospitalDavid A. Axelrod - University of IowaMark A. Schnitzler - Saint Louis UniversityRosemary Ouseph - Saint Louis UniversityFranco H. Cabeza Rivera - University of MississippiBertram L. Kasiske - Hennepin County Medical CenterKenneth J. Woodside - University of MichiganRonald F. Parsons - Emory University
- Resource Type
- Journal article
- Publication Details
- Transplantation direct, Vol.6(9), pp.e599-e599
- DOI
- 10.1097/TXD.0000000000001043
- PMID
- 32903964
- PMCID
- PMC7447442
- NLM abbreviation
- Transplant Direct
- ISSN
- 2373-8731
- eISSN
- 2373-8731
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 10
- Grant note
- Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation HHSH250201000018C / Minneapolis Medical Research Foundation (MMRF) (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation)
- Language
- English
- Date published
- 09/01/2020
- Academic Unit
- Surgery
- Record Identifier
- 9984322816802771
Metrics
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