The benefit of kidney transplantation versus remaining on the waitlist depends on patients' baseline comorbidities: a retrospective study

Background: Patients with end-stage renal disease present comorbidities
that increase mortality risk on the waitlist and after kidney
transplantation. This study aimed to determine the impact of baseline
comorbidities on the risk of death after kidney transplantation compared
to remaining on the waitlist. Methods: Records of waitlisted patients were
retrospectively analyzed. Multivariable time-dependent Cox-regression
model was used to determine the initial and the lowest relative
hazard-risk of death (HRD) after exposure to kidney transplantation.
Results: 1692 patients were included in the study. Patients without
comorbidities had the relative HRD 3-fold higher, immediately after kidney
transplantation, but it reduced progressively, reaching equality to
waitlist at 75 days and a HRD of 0.28 thereafter (p<0.001).
Patients with Diabetes and coronary artery disease had an initial relative
HRD of 2.41 (p=0.009) and 2.68 (p=0.009) and matched to the waitlist at
175 and 200 days, respectively. Patients with peripheral vascular disease,
had an initial relative HRD 3.6-fold in the first 240 days (p=0.008) and
patients with congestive heart failure a relative HRD of 7.47 (p=0.07).
Both declined rapidly, reaching equality at 110 days. Finally, all
comorbidities, except cerebrovascular disease, presented lower HRD on
long-term follow-up. Conclusions: This study shows that the time and the
range of relative HRD between kidney transplantation and waitlist varies
depending upon the patients´ baseline comorbidities.