Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation
Rattachement africain : be, nl, si, no, dk, it, fi, fr, gb, es, ch, us, se. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
OBJECTIVE: To quantify the survival benefit of deceased donor kidney transplantation versus continued dialysis according to patients' characteristics (age, diabetes, cardiovascular disease), donor quality (standard criteria donor or expanded criteria donor) and donor retrieval type (donation after brain death or donation after circulatory death). DESIGN: Target trial emulation. SETTING: European Renal Association Registry data from five countries or regions: Catalonia (Spain), Denmark, France, Norway, and the UK. PARTICIPANTS: Patients aged ≥20 years receiving dialysis and waitlisted for a first deceased donor kidney-only transplant between 2000 and 2019. MAIN OUTCOME MEASURES: Five year patient survival following deceased donor kidney transplantation versus continued dialysis within monthly sequential trials. Flexible parametric spline models estimated adjusted five year patient survival across recipient age. RESULTS: Of 64 036 waitlisted patients receiving dialysis, 39 244 received a deceased donor kidney transplant: 16 897 (43.1%) from a standard criteria donor/donation after brain death donor, 4324 (11.0%) from a standard criteria donor/donation after circulatory death donor, 14 799 (37.7%) from an expanded criteria donor/donation after brain death donor, and 3224 (8.2%) from an expanded criteria donor/donation after circulatory death donor. Standard criteria donor/donation after brain death and standard criteria donor/donation after circulatory death transplantation showed higher estimated five year survival compared with continued dialysis regardless of recipient age. However, the survival benefit associated with expanded criteria donor/donation after brain death transplantation and, particularly, expanded criteria donor/donation after circulatory death transplantation decreased with increasing recipient age, albeit with greater statistical uncertainty among older patients. For example, among 75 year olds, estimated five year survival following expanded criteria donor/donation after circulatory death transplantation did not differ significantly from that with continued dialysis (59% (95% confidence interval 51% to 66%) versus 55% (54% to 55%); hazard ratio 0.97, 95% confidence interval 0.70 to 1.33), irrespective of diabetes or cardiovascular disease status. This group had a threefold higher early post-transplant mortality than those continuing dialysis. CONCLUSIONS: Standard criteria donor kidney transplantation was consistently associated with a survival benefit compared with continued dialysis. By contrast, the survival benefit associated with expanded criteria donor transplantation declined with increasing recipient age, particularly for expanded criteria donor/donation after circulatory death transplantation, such that the oldest recipients had a smaller and more statistically uncertain estimated survival advantage over continued dialysis.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation
- Date Crossref
- 18/09/2026
- Éditeur
- BMJ
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Antwerp pays non établi dans la noticeUniversité ou école supérieure
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Antwerp University Hospital Department of Nephrology pays non établi dans la noticeOrganisme public
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Amsterdam University Medical Centers pays non établi dans la noticeÉtablissement de santé
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Leiden University Medical Center pays non établi dans la noticeOrganisme public
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University of Ljubljana pays non établi dans la noticeUniversité ou école supérieure
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Ljubljana University Medical Centre pays non établi dans la noticeÉtablissement de santé
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Oslo University Hospital Department of Transplantation Medicine pays non établi dans la noticeÉtablissement de santé
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University of Oslo Department of Pharmacy pays non établi dans la noticeUniversité ou école supérieure
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University of Southern Denmark Department of Clinical Research pays non établi dans la noticeUniversité ou école supérieure
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Odense University Hospital Department of Nephrology pays non établi dans la noticeOrganisme public
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University of Verona pays non établi dans la noticeUniversité ou école supérieure
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Finnish Institute for Health and Welfare Finnish Registry for Kidney Diseases pays non établi dans la noticeOrganisme public
University of Antwerp, Department of Nephrology — Antwerp University Hospital et Amsterdam University Medical Centers, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.