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Propensity Score-Matched Analysis of the Survival Benefit from Kidney Transplantation in Patients with End-Stage Renal Disease

1,2,3,4, 1,2, 5,6 and 2,7,8,*
1
Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung 400, Taiwan
2
Graduate Institute of Biomedical Sciences and School of Medicine, China Medical University, Taichung 404, Taiwan
3
Graduate Institute of Biomedical Sciences, College of Life Science, National Chung Hsing University, Taichung 404, Taiwan
4
School of Medicine, Chung-Shan Medical University, Taichung 404, Taiwan
5
Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
6
College of Medicine, China Medical University, Taichung 404, Taiwan
7
Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 404, Taiwan
8
Department of Bioinformatics and Medical Engineering, Asia University, Taichung 404, Taiwan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(11), 388; https://doi.org/10.3390/jcm7110388
Received: 1 October 2018 / Revised: 19 October 2018 / Accepted: 24 October 2018 / Published: 26 October 2018
(This article belongs to the Section Nephrology & Urology)
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Abstract

Background: Several comparison studies have suggested that kidney transplantation (KT) could reduce mortality in patients with end-stage renal disease (ESRD). Selection criteria bias is common in the selection of dialysis patients for control groups. In this study, we compared the survival outcome between KT recipients and comparable propensity score-matched dialysis patients. Methods: We used Taiwan’s National Health Insurance Research Database to identify patients newly diagnosed with ESRD between 2000 and 2010. We separated them into two groups: a KT group and non-KT dialysis-only group. To evaluate the survival outcome, we compared each patient with KT to a patient on dialysis without KT using propensity score matching. Results: In total, 1276 KT recipients and 1276 propensity score-matched dialysis patients were identified. Compared with the propensity score-matched dialysis patients, the patients who underwent KT exhibited significantly higher 5-year and 10-year survival rates (88% vs. 92% and 74% vs. 87%, both p < 0.05). The crude and adjusted hazard ratios for mortality were 0.55 and 0.52 in patients with KT (both p < 0.001). Mortality was insignificantly higher for patients who were on dialysis for longer than 1 year prior to KT compared with those on dialysis for less than 1 year. Conclusion: This study used a propensity score-matched cohort to confirm that KT is associated with lower risk of mortality than dialysis alone in patients newly diagnosed with ESRD. View Full-Text
Keywords: dialysis; kidney transplantation; propensity score matching; survival dialysis; kidney transplantation; propensity score matching; survival
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Wu, M.-J.; Yu, T.-M.; Lin, C.-L.; Kao, C.-H. Propensity Score-Matched Analysis of the Survival Benefit from Kidney Transplantation in Patients with End-Stage Renal Disease. J. Clin. Med. 2018, 7, 388.

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