Background: This study aimed to compare the survival benefit of kidney transplantation (KT) versus maintenance dialysis in end-stage kidney disease (ESKD) patients with prior acute myocardial infarction (AMI).
Methods: Patients with ESKD and a previous AMI have less access to KT. Data on ESKD patients with an AMI history who underwent first KT or dialysis between January 2007 and December 2018 were extracted from the Korean National Health Insurance Service database. Patients who underwent KT (n=423) were chronologically matched in a 1:3 ratio with those maintained on dialysis (n=1,269) at the corresponding dates, based on time-conditional propensity scores.
Results: In the KT group, there were nine (2.1%) deaths and 13 (3.1%) major adverse cardiovascular events (MACE) during the postoperative hospital stay. The 1-, 5-, and 10-year cumulative incidences for all-cause mortality were 12.6%, 39.1%, and 60.1% in the dialysis group and 3.1%, 7.2%, and 14.5% in the KT group. Adjusted hazard ratios (HRs) of KT versus dialysis were 0.17 (95% confidence interval [CI], 0.12–0.24; P<0.001) for mortality and 0.38 (95% CI, 0.23–0.51; P<0.001) for MACE. Of the MACE components, KT was most protective against cardiovascular death (HR, 0.23; 95% CI, 0.12–0.42; P<0.001). Protective effects of KT for all-cause mortality and MACE were consistent across various subgroups, including patients at higher risk (e.g., age >65 years, recent AMI [<6 months], congestive heart failure).
Conclusions: KT is more beneficial than maintenance dialysis in reducing all-cause mortality and MACE in ESKD patients with a prior AMI.