Research Article: Factors affecting mortality during the waiting time for kidney transplantation: A nationwide population-based cohort study using the Korean Network for Organ Sharing (KONOS) database

Date Published: April 12, 2019

Publisher: Public Library of Science

Author(s): Sunhwa Lee, Kyung Don Yoo, Jung Nam An, Yun Kyu Oh, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee, Ping-Hsun Wu.


Long waiting time for deceased donor kidney transplant is inevitable due to the scarcity of donor, resulting in highlighting the importance of waiting time care. We analyzed the Korean Network for Organ Sharing (KONOS) database to assess the impact of waiting time on post-transplant survival outcomes and investigate risk factors for mortality by waiting time based on a complete enumeration survey in Korea.

We analyzed all persons aged over 18 years in deceased donor kidney transplant cases enrolled in the Korean Network for Organ Sharing (KONOS) database from January 2000 to January 2015. The primary end point was all-cause mortality after enrollment.

Of the 24,296 wait-listed subjects on dialysis, 5,255 patients received kidney transplants from deceased donors, with a median waiting time of 4.5 years. Longer waiting times had distinct deleterious effects on overall survival after transplantation. While waiting for a transplant, patients with diabetes were more likely to die before transplantation (HR 1.515, 95% CI 1.388–1.653, p<0.001). Age was another significant risk factor for mortality. Only 56% of people aged 65 years survived after 10 years of waiting, whereas 86% of people aged 35 years survived after 10 years. Moreover, women on the waiting list were more likely to live longer than men on the list. More attention should be focused on patients with a higher risk of mortality while waiting for a deceased donor kidney transplant, such as patients with diabetes, those of advanced age, and those who are male.

Partial Text

The number of patients with end-stage renal disease (ESRD) is increasing rapidly at a rate of 5–7% per year [1]. In South Korea, the total number of patients receiving renal replacement therapy (RRT) has increased from 746 to 1,464 patients per million population during the past 10 years (from 2006 to 2016), whereas kidney transplantation cases have increased from 550 to 1,112 patients per million population. Although kidney transplantation is the treatment of choice due to its superior outcomes in terms of survival rate [2–4], quality of life and cost utility [5–7], the discrepancy between the supply and demand of kidneys continues to grow. As of December 2017, 19,807 patients were on the Korean Network for Organ Sharing (KONOS) waiting list for kidney transplantation. During the last decade in Korea, a 22.4% annual increase in the kidney transplantation waiting list was recorded. Consequently, the waiting time for kidney transplantation is an issue of growing importance.

In the present study, we performed risk factor analysis based on waiting time for 24,296 individuals with ESRD on the waiting list for renal transplantation. Longer waiting periods had an obvious negative effect on overall mortality after transplantation. During that time, patients who were male, of advanced age, or had diabetes were vulnerable to death. We also found that patients who were of advanced age, had diabetes, had blood type O, or had prior kidney transplant experience received donor kidneys later than others on the list.




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