BACKGROUND: A substantial number of patients return to dialysis therapy after a renal transplant fails. It is not clear whether mortality increases among patients with graft failure relative to those on the waiting list who have not yet received a kidney transplant. METHODS: Data from the Scientific Registry of Transplant Recipients were analyzed (N = 175,436). Cox regression with time-dependent covariates was used to compare mortality between post-graft failure dialysis patients and primary transplant candidates on dialysis therapy. Mortality hazard ratios (HRs) were adjusted for age, sex, race, cause of end-stage renal disease, pre-waiting list time on dialysis therapy, calendar year of wait-listing, and organ procurement organization. RESULTS: Overall, the post-graft failure dialysis group experienced a significant 78% greater mortality (HR, 1.78; P < 0.0001) relative to the transplant candidate group. The post-graft failure dialysis/transplant candidate HR was relatively constant across age groups, but significantly greater (P < 0.0001) among patients with diabetes (HR, 1.93) than among those without diabetes (HR, 1.69). The HR was greatest during the first week after graft failure (HR, 13.6; P < 0.0001) and decreased steadily thereafter. However, despite leveling off, the HR remained significantly elevated well after graft failure, including the 5- to 10-year period after graft failure. CONCLUSION: Based on national data, mortality among patients on dialysis therapy after primary graft failure increases significantly relative to mortality among patients still awaiting primary kidney transplantation. Additional studies are urgently needed to define the mechanism of the increased risk and strategies to decrease mortality.
BACKGROUND: A substantial number of patients return to dialysis therapy after a renal transplant fails. It is not clear whether mortality increases among patients with graft failure relative to those on the waiting list who have not yet received a kidney transplant. METHODS: Data from the Scientific Registry of Transplant Recipients were analyzed (N = 175,436). Cox regression with time-dependent covariates was used to compare mortality between post-graft failure dialysis patients and primary transplant candidates on dialysis therapy. Mortality hazard ratios (HRs) were adjusted for age, sex, race, cause of end-stage renal disease, pre-waiting list time on dialysis therapy, calendar year of wait-listing, and organ procurement organization. RESULTS: Overall, the post-graft failure dialysis group experienced a significant 78% greater mortality (HR, 1.78; P < 0.0001) relative to the transplant candidate group. The post-graft failure dialysis/transplant candidate HR was relatively constant across age groups, but significantly greater (P < 0.0001) among patients with diabetes (HR, 1.93) than among those without diabetes (HR, 1.69). The HR was greatest during the first week after graft failure (HR, 13.6; P < 0.0001) and decreased steadily thereafter. However, despite leveling off, the HR remained significantly elevated well after graft failure, including the 5- to 10-year period after graft failure. CONCLUSION: Based on national data, mortality among patients on dialysis therapy after primary graft failure increases significantly relative to mortality among patients still awaiting primary kidney transplantation. Additional studies are urgently needed to define the mechanism of the increased risk and strategies to decrease mortality.
Authors: David J Taber; Mulugeta Gebregziabher; Elizabeth H Payne; Titte Srinivas; Prabhakar K Baliga; Leonard E Egede Journal: Transplantation Date: 2017-02 Impact factor: 4.939
Authors: David J Taber; Kelly J Hunt; Cory E Fominaya; Elizabeth H Payne; Mulugeta Gebregziabher; Titte R Srinivas; Prabhakar K Baliga; Leonard E Egede Journal: Hypertension Date: 2016-07-11 Impact factor: 10.190
Authors: Jing Zhou; Lingfeng Qin; Tai Yi; Rahmat Ali; Qingle Li; Yang Jiao; Guangxin Li; Zuzana Tobiasova; Yan Huang; Jiasheng Zhang; James J Yun; Mehran M Sadeghi; Frank J Giordano; Jordan S Pober; George Tellides Journal: Circ Res Date: 2015-09-23 Impact factor: 17.367
Authors: Jeffrey Perl; Jinyao Zhang; Brenda Gillespie; Bjorn Wikström; Joan Fort; Takeshi Hasegawa; Douglas S Fuller; Ronald L Pisoni; Bruce M Robinson; Francesca Tentori Journal: Nephrol Dial Transplant Date: 2012-09-30 Impact factor: 5.992