Similar Outcomes for Canadian Renal Transplant Recipients Followed Up in Transplant Centers and Satellite Clinics

Background. A significant proportion of long-term care for renal transplant recipients (RTRs) in Canada is provided by community nephrologists in satellite clinics (SCs). The outcomes of RTRs followed up in SCs have not been formally compared with those followed up in transplant centers (TCs). Methods. This multicenter retrospective study from 13 TCs and SCs across Canada compared patient and graft outcomes in RTRs with a functioning graft more than or equal to 18 months. Data were abstracted at 6 to 18 months posttransplantation, and at last visit (if > 18 months). Patients were stratified in a 1:1 ratio between TCs and SCs, and by a 3:1 ratio between cyclosporine A and tacrolimus. The primary outcome was change (Delta) in Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR) from 6 to 18 months posttransplantation (Delta eGFR(M18-6)). Secondary outcomes included the prevalence of hyperlipidemia, diabetes, and hypertension. Results. A total of 264 RTRs followed at TCs and SCs demonstrated broad similarity in baseline recipient and donor characteristics. Delta eGFR(M18-6) were similar for TCs versus SCs and better for tacrolimus versus cyclosporine A (P=0.022). There was no difference in lipid levels between TCs and SCs during 6 to 18 months, although low-density lipoprotein cholesterol was lower in SCs versus TCs at most recent visit (2.6 vs. 2.3 mmol/L; P=0.003). Fasting blood glucose levels were similar in TCs and SCs. Comparable target blood pressure levels were achieved, and the prevalence of hypertension was similar for both TCs and SCs at all time points. Conclusion. Short-term graft and patient outcomes are similar in TC and SC RTRs, supporting the feasibility of follow-up patient care outside major TCs.