• Isabelle Ethier, Yeoungjee Cho, Carmel Hawley, Elaine M Pascoe, Matthew A Roberts, David Semple, Annie-Claire Nadeau-Fredette, Germaine Wong, Wai H Lim, Matthew P Sypek, Andrea K Viecelli, Scott Campbell, Carolyn van Eps, Nicole M Isbel, and David W Johnson.
• Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
• Nephrol. Dial. Transplant. 2021 Sep 27; 36 (10): 1937-1946.

BackgroundIn the era of organ shortage, home hemodialysis (HHD) has been identified as the possible preferential bridge to kidney transplantation. Data are conflicting regarding the comparability of HHD and transplantation outcomes. This study aimed to compare patient and treatment survival between HHD patients and kidney transplant recipients.MethodsThe Australia and New Zealand Dialysis and Transplant Registry was used to include incident HHD patients on Day 90 after initiation of kidney replacement therapy and first kidney-only transplant recipients in Australia and New Zealand from 1997 to 2017. Survival times were analyzed using the Kaplan-Meier product-limit method comparing HHD patients with subtypes of kidney transplant recipients using the log-rank test. Adjusted analyses were performed with multivariable Cox proportional hazards regression models for time to all-cause mortality. Time-to-treatment failure or death was assessed as a composite secondary outcome.ResultsThe study compared 1411 HHD patients with 4960 living donor (LD) recipients, 6019 standard criteria donor (SCD) recipients and 2427 expanded criteria donor (ECD) recipients. While LD and SCD recipients had reduced risks of mortality compared with HHD patients [LD adjusted hazard ratio (HR) = 0.57, 95% confidence interval (CI) 0.46-0.71; SCD HR = 0.65 95% CI 0.52-0.79], the risk of mortality was comparable between ECD recipients and HHD patients (HR = 0.90, 95% CI 0.73-1.12). LD, SCD and ECD kidney recipients each experienced superior time-to-treatment failure or death compared with HHD patients.ConclusionsThis large registry study showed that kidney transplant offers a survival benefit compared with HHD but that this advantage is not significant for ECD recipients.© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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