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Mortality After Kidney Transplantation: A Comparison Between the United States and Canada
Author(s) -
Kim S.J.,
Schaubel D.E.,
Fenton S.S.A.,
Leichtman A.B.,
Port F.K.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01141.x
Subject(s) - medicine , dialysis , transplantation , kidney transplantation , proportional hazards model , mortality rate , diabetes mellitus , renal replacement therapy , demography , intensive care medicine , sociology , endocrinology
There is a paucity of comparative studies on country‐specific outcomes in kidney transplantation. We compared post‐transplant mortality among primary, adult, solitary kidney transplant recipients (KTR) from the United States (n = 70 708) and Canada (n = 5773), between January 1, 1991 and December 31, 1998, using data from the Scientific Registry of Transplant Recipients and the Canadian Organ Replacement Register. Multivariable Cox regression revealed higher adjusted post‐transplant mortality among U.S. (vs. Canadian) KTR (HR = 1.35 [95% CI 1.24, 1.47; p < 0.005]). Mortality risk in the first post‐transplant year was similar in both countries but higher in the United States beyond the first year (HR = 1.49–1.53; p < 0.005). There was no difference in mortality among patients transplanted within 1 year of starting dialysis, but mortality was increased in U.S. (vs. Canadian) patients after 1–2 and 4+ years on dialysis (HR = 1.36–1.66; p < 0.005). Greater mortality was also seen in U.S. patients with diabetes mellitus and/or graft failure. In conclusion, there are considerable differences in the survival of KTR in the United States and Canada. A detailed examination of factors contributing to this variation may yield important insights into improving outcomes for all KTR.