Lim WH, et al. - The goal of this investigation was to shed light on the association of vascular disease before kidney transplantation with transplant and patient survival after transplantation. Furthermore, the impact of diabetes on this link was also assessed. Findings revealed that the presence of diabetes modified the effect of vascular disease on long-term outcomes, whereby excess risks for death and transplant loss were more apparent in recipients without diabetes.

Methods

• This study included all deceased donor kidney transplant recipients recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for 1990 to 2012.
• In this study, vascular disease burden was included as a predictor.
• Outcomes included all-cause mortality and overall transplant loss, and using 2-way interaction terms, researchers evaluated potential interactions between diabetes and vascular disease for mortality and transplant loss.

Results

• This study included a total of 7,128 recipients with 58,120 patient-years of follow-up, of these, 854 (12.0%) and 263 (3.7%) had vascular diseases at 1 and 2 or more sites, respectively.
• Fifteen years after transplantation, the reported overall survival for recipients without vascular disease was 65% compared with 35% and 22% among recipients with vascular disease at 1 and 2 or more sites, respectively (P < 0.001).
• The adjusted HRs for mortality and transplant loss were 1.75 (95% CI, 1.39-2.20; P < 0.001) and 1.61 (95% CI, 1.30-1.99; P < 0.001), respectively, for recipients with 2 or more vascular diseases when compared with the recipients without vascular disease.
• Compared with those without vascular disease, adjusted HRs for mortality and transplant loss were 2.10 (95% CI, 1.56-2.82; P < 0.001) and 1.84 (95% CI, 1.39-2.42; P < 0.001), respectively, among recipients without diabetes but with 2 or more vascular diseases.
• Data did not report similar associations for recipients with diabetes mellitus (P for interaction < 0.001).