National access to renal transplantation and post-transplant survival among patients with diabetes: deceased and living donor outcomes
Authors' conclusion
Proceeding to transplantation offers significant survival benefit for end-stage renal disease patients with diabetes, with LDKT offering superior survival compared with DDKT. By reducing time on the waiting list and providing superior grafts, the benefit of LDKT is particularly enhanced among patients with diabetes, and targeted efforts should be made to expand living donor access for this population.
Study context
- Population
- Adults placed on the kidney waiting list between January 2014 and January 2024 (UNOS STAR file), with and without diabetes and end-stage renal disease
- Exposure
- Living donor kidney transplantation (LDKT) vs deceased donor kidney transplantation (DDKT) in patients with diabetes; diabetes vs no diabetes
- Outcome
- Survival benefit of LDKT vs DDKT among patients with diabetes
Methodological detailsregistry-based (UNOS STAR file)
- Registry-based (UNOS STAR file)
Main finding
As reported in the abstract
Life-years from transplant, LDKT vs DDKT
18.2 years vs 14.1 years
Life-years gained (relative increase over 10 years), LDKT vs DDKT; p<0.001
29% vs 24%
LDKT decreased equal survival (ES)
19 months
LDKT decreased equal risk (ER)
30 months
Observational data: associations, not effects.
Further findings
| Outcome | Subdistribution HR (95% CI) | |
|---|---|---|
| 10-year waitlist failure, diabetesvs no diabetes | 2.27 (2.23–2.32) | |
| 0.512Subdistribution hazard ratio (log scale) |
Kidney Donor Profile Index of DDKT grafts, diabetes vs no diabetes
P < 0.001
Original publication
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