Patient and Kidney Allograft Survival in Recipients with End Stage Renal Disease from Amyloidosis.

Background: Outcomes following kidney transplantation for patients with amyloidosis-associated end-stage renal disease (ESRD) have not been well characterized. Methods: We performed a retrospective propensity score matched cohort study with Cox proportional hazards modeling using data from the United Network of Organ Sharing including patients transplanted from 1987 to 2015 (N=310 629). Results: Amyloidosis patients (N=576) had higher rates of death (HR 1.58, 95% CI 1.28-1.95) and graft loss (HR 1.49, 95% CI 1.19-1.87) compared to nonamyloidosis patients. The results were similar when the cohort was restricted to patients transplanted on or after 2001 (HR 1.72, 95% CI 1.31-2.26 for death, HR 1.77, 95% CI 1.35-2.33 for graft loss). However, there was no significant difference in risk of death or graft loss when amyloidosis patients were compared to those with diabetes-associated ESRD (mortality HR 0.99, 95% CI 0.84-1.17; allograft loss HR 1.00, 95% CI 0.84-1.20), or when compared to elderly patients (age >65 years at the time of transplant) (mortality HR 0.99, 95% CI 0.81-1.21; graft loss HR 1.02, 95% CI 0.82-1.26). Conclusions: For patients with amyloidosis-associated ESRD deemed suitable for transplantation, patient and graft survival are diminished compared to kidney transplant recipients overall, but are comparable to other high-risk subgroups. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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