1085 — Long-Term Evaluation of Survival among Solid Organ Transplants among Veterans from 1995-2007
Young BA (HSR&D Northwest Center of Excellence and the Seattle ERIC), Pergam SA
(University of Washington), Maynard C
(HSR&D Northwest Center of Excellence), Forsberg CW
(Seattle ERIC), Spigner C
(University of Washington), Rees C
(University of Washington), Smith N
(Seattle ERIC), Dick A
(University of Washington), Backhus LM
(VA Puget Sound Health Care System)
Comparison of long-term solid organ transplant (SOT) survival has not been evaluated in systems where universal access to medications and healthcare are available.
We evaluated the risk of death among veterans who received SOT and were treated in the Veterans Affairs (VA) health care system from 1995-2007. Predictor variables included demographics, year of transplantation, and VA status, while mortality was the primary outcome of interest. Demographics were compared using Fisher’s exact and Wilcoxon rank sum tests. Cox proportional hazards models were used to determine risk of death.
We identified 1,332 subjects who met inclusion criterion. Of those, 443 subjects died during 12 years of follow up. The average follow up time was 5.2 years for those who survived and 3.2 years for those who died. Those who died were more likely to be older, white, and to have had a liver or heart transplant. Multivariable analyses adjusted for age, race, year of transplant, VA status, and geographic region showed that compared to kidney transplants, liver (HR = 1.70, 95% CI = 1.35-2.13), heart (HR = 1.96, 95% CI = 1.41-2.71), and other (HR = 3.75, 95% CI = 2.53-5.54) transplants had greater risk of death. There was no significant difference in survival among whites, African Americans, and other minority Veterans. Veterans transplanted more recently had lower risk of death (2004+, HR = 0.45, 95% CI = 0.31, 0.64 or 2000-2004, HR = 0.75, 95% CI = 0.59, 0.93) compared to those transplanted from 1995-1999.
We conclude that heart, liver, and other organ transplants have a greater risk of death compared to kidney transplants, and Veterans transplanted more recently are more likely to survive compared to those transplanted a decade ago. Finally, no significant racial/ethnic differences in long-term survival were found.
In a unique 12-year longitudinal follow up study among patients treated within the VA health care system, Veterans with heart, liver, or other organ transplants have greater mortality compared to Veterans who received kidney transplants; however, no significant differences by race/ethnicity were detected in survival rates.