Introduction: Kidney transplantation is the standard treatment option for patients with end-stage chronic kidney disease. However, early kidney transplantation is not always possible, and many patients require renal replacement therapy. This study aims to evaluate the short and long-term outcomes after kidney transplantation in patients undergoing dialysis therapy before transplantation.
Methods: A retrospective cohort of renal transplant patients older than 18 years of age were evaluated during the years 2005-2018. A descriptive analysis was performed. A proportional Cox-Hazard model was used to evaluate the relationship between patient and transplant survival and pre-transplant dialysis. An analysis of variance was used to compare the glomerular filtration rate during the first two years after transplantation.
Results: Between 2005-2018, 925 kidney transplants were performed, of which 289 required peritoneal dialysis, 439 haemodialysis and 197 did not require dialysis. Patient and transplant survival rates at 6, 12, 24, 48, 60 months after kidney transplantation were 97.5%, 96.7%, 96.0%, 93.7%, 92.3%, 94.5%, 92.9%, 90.5%, 84.8%, 81.1%. No statistically significant difference was found between peritoneal dialysis patients and hemodialysis patients (p=0.402, p=0.180). Acute rejection occurred in 8.1% of patients in the first year after transplantation and in 13.2% during the entire follow-up. Glomerular filtration rate values were similar in patients with and those without pre-transplant dialysis
Conclusions: There were no significant statistical differences in short and long-term outcomes among patients undergoing pre-transplant dialysis vs. no.
Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT. Preemptive kidney transplantation: The advantage and the advantaged. J Am Soc Nephrol. 2002. doi:10.1097/01.ASN.0000013295.11876.C9
Jay CL, Dean PG, Helmick RA, Stegall MD. Reassessing preemptive kidney transplantation in the united states: Are we making progress? Transplantation. 2016. doi:10.1097/TP.0000000000000944
Burkart J. The future of peritoneal dialysis in the United States: Optimizing its use. In: Clinical Journal of the American Society of Nephrology. ; 2009. doi:10.2215/CJN.04760709
Mehrotra R, Kermah D, Fried L, et al. Chronic peritoneal dialysis in the United States: Declining utilization despite improving outcomes. J Am Soc Nephrol. 2007. doi:10.1681/ASN.2006101130
Hd F, States U, Services M, et al. USRDS 2018 Annual Date Report - Chapter 5 : Mortality. United States Ren Data Syst 2018 USRDS Annu data Rep Epidemiol kidney Dis United States Natl Institutes Heal Natl Inst Diabetes Dig Kidney Dis Bethesda, MD, 2018. 2018.
Inrig JK, Sun JL, Yang Q, Briley LP, Szczech LA. Mortality by dialysis modality among patients who have end-stage renal disease and are awaiting renal transplantation. Clin J Am Soc Nephrol. 2006. doi:10.2215/CJN.00580705
Goldfarb-Rumyantzev AS, Hurdle JF, Scandling JD, Baird BC, Cheung AK. The role of pretransplantation renal replacement therapy modality in kidney allograft and recipient survival. Am J Kidney Dis. 2005. doi:10.1053/j.ajkd.2005.05.013
Lin HT, Liu FC, Lin JR, Pang ST, Yu HP. Impact of the pretransplant dialysis modality on kidney transplantation outcomes: A nationwide cohort study. BMJ Open. 2018. doi:10.1136/bmjopen-2017-020558
Tang M, Li T, Liu H. A comparison of transplant outcomes in peritoneal and hemodialysis patients: A meta-analysis. Blood Purif. 2016. doi:10.1159/000446272
Dipalma T, Fernández-Ruiz M, Praga M, et al. Pre-transplant dialysis modality does not influence short- or long-term outcome in kidney transplant recipients: analysis of paired kidneys from the same deceased donor. Clin Transplant. 2016. doi:10.1111/ctr.12793
Schwenger V, Döhler B, Morath C, Zeier M, Opelz G. The role of pretransplant dialysis modality on renal allograft outcome. Nephrol Dial Transplant. 2011. doi:10.1093/ndt/gfr132
Kramer A, Jager KJ, Fogarty DG, et al. Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation. Nephrol Dial Transplant. 2012. doi:10.1093/ndt/gfs450
López-Oliva MO, Rivas B, Pérez-Fernández E, et al. Pretransplant peritoneal dialysis relative to hemodialysis improves long-term survival of kidney transplant patients: A single-center observational study. Int Urol Nephrol. 2014. doi:10.1007/s11255-013-0521-0
Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa AG. Influence of Dialysis Duration and Modality on Kidney Transplant Outcomes. Transplant Proc. 2009. doi:10.1016/j.transproceed.2009.01.063
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