Kevin C Mange1, Marshall M Joffe, Harold I Feldman. 1. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA. kmange@cceb.med.upenn.edu
Abstract
BACKGROUND: The relationship between transplantation prior to chronic dialysis initiation and the pattern of acute rejection of kidneys from living donors (LDKT) has not been fully explored. METHODS: Using data provided by the United States Renal Data System, we performed a retrospective cohort study fitting multivariate proportional hazards models to characterize the association of chronic use of dialysis prior to transplantation [non-pre-emptive LDKT (non-PLDKT)] and acute rejection, and to examine if this association varies throughout the first year. RESULTS: Non-PLDKT was associated with a 2.5-fold higher rate of biopsy-confirmed rejection during the first month [adjusted HR 2.5, 95% confidence interval (1.85-3.33)], compared with no dialysis prior to transplantation. Increasing duration of pre-transplant dialysis was associated with increasing rate of biopsy-confirmed acute rejection during the first month (P = 0.001 for trend). Over the first year, there was a diminishing relationship between non-PLDKT and acute rejection: 2.5-, 2.22-, 2.13- and 1.78-fold elevation in the episodes of biopsy-confirmed acute rejection during the first, second, third through to the sixth and seventh through to the twelfth month post-transplant, respectively (P = 0.05 for trend). CONCLUSIONS: The waning of the association of non-PLDKT with acute rejection over time supports the hypothesis that dialysis exposure prior to transplantation may modulate the immune system to increase the rates of acute rejection.
BACKGROUND: The relationship between transplantation prior to chronic dialysis initiation and the pattern of acute rejection of kidneys from living donors (LDKT) has not been fully explored. METHODS: Using data provided by the United States Renal Data System, we performed a retrospective cohort study fitting multivariate proportional hazards models to characterize the association of chronic use of dialysis prior to transplantation [non-pre-emptive LDKT (non-PLDKT)] and acute rejection, and to examine if this association varies throughout the first year. RESULTS: Non-PLDKT was associated with a 2.5-fold higher rate of biopsy-confirmed rejection during the first month [adjusted HR 2.5, 95% confidence interval (1.85-3.33)], compared with no dialysis prior to transplantation. Increasing duration of pre-transplant dialysis was associated with increasing rate of biopsy-confirmed acute rejection during the first month (P = 0.001 for trend). Over the first year, there was a diminishing relationship between non-PLDKT and acute rejection: 2.5-, 2.22-, 2.13- and 1.78-fold elevation in the episodes of biopsy-confirmed acute rejection during the first, second, third through to the sixth and seventh through to the twelfth month post-transplant, respectively (P = 0.05 for trend). CONCLUSIONS: The waning of the association of non-PLDKT with acute rejection over time supports the hypothesis that dialysis exposure prior to transplantation may modulate the immune system to increase the rates of acute rejection.
Authors: Evangelos M Mazaris; Jeremy S Crane; Anthony Nu Warrens; Glenn Smith; Paris Tekkis; Vassilios E Papalois Journal: Int Urol Nephrol Date: 2011-05-26 Impact factor: 2.370
Authors: Erica Winnicki; Kirsten L Johansen; Michael D Cabana; Bradley A Warady; Charles E McCulloch; Barbara Grimes; Elaine Ku Journal: J Am Soc Nephrol Date: 2019-07-18 Impact factor: 10.121
Authors: Françoise G Pradel; Rahul Jain; C Daniel Mullins; Joseph A Vassalotti; Stephen T Bartlett Journal: Clin J Am Soc Nephrol Date: 2008-10-01 Impact factor: 8.237
Authors: Katja Kloss; Sohal Ismail; Steef Redeker; Lothar van Hoogdalem; Annemarie Luchtenburg; Jan J V Busschbach; Jacqueline van de Wetering Journal: BMJ Open Date: 2019-09-26 Impact factor: 2.692