For non-preemptive living donor kidney transplant recipients, longer pretransplant dialysis exposure is associated with a higher risk of allograft failure, reports a study in the American Journal of Kidney Diseases.
The retrospective study included 77,607 adult, first-time, kidney-only living donor transplant recipients reported to the Scientific Registry of Transplant Recipients between 2000 and 2016. Of these, 51,390 underwent non-preemptive transplantation. Duration of pretransplant dialysis exposure was examined for association with kidney transplant failure from any cause including death. Median duration of dialysis exposure in the non-preemptive transplant group was 14 months.
Patients with longer pretransplant dialysis exposure were at higher risk of transplant failure. Compared to dialysis exposure of less than 3 months, hazard ratio for transplant failure from any cause increased from 1.16 for patients with 6 to 9 months of exposure to 1.60 for those with more than 60 months of exposure.
Time on dialysis varied considerably among transplant centers: median exposure was 11.0 months for centers in the 10th percentile versus 18.9 months for those in the 90th percentile. Pretransplant dialysis exposure was shorter at centers with higher proportions of living donor transplants.
Other factors associated with longer dialysis exposure were black race, low income, nonprivate insurance, less than high school education, and longer time not working for income. Even for patients with these characteristics, dialysis exposure varied between transplant centers.
The new results show that longer duration of dialysis before living donor kidney transplantation is associated with a higher risk of transplant failure from any cause. Duration of pretransplant dialysis exposure varies between centers and is associated with patient sociodemographic factors. “Strategies to increase the efficiency of living donor transplantation in non-preemptive recipients are warranted,” the researchers conclude [Gill JS, et al. Variation in dialysis exposure prior to nonpreemptive living donor kidney transplantation in the United States and its association with allograft outcomes. Am J Kidney Dis 2017; DOI: https://doi.org/10.1053/j.ajkd.2017.11.012].