Ilkka Helanterä1, Kaija Salmela, Lauri Kyllönen, Petri Koskinen, Carola Grönhagen-Riska, Patrik Finne. 1. 1 Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland. 2 Department of Transplant Surgery, Helsinki University Central Hospital, Helsinki, Finland. 3 Finnish Registry for Kidney Diseases, Helsinki, Finland. 4Address correspondence to: Ilkka Helanterä M.D., Ph.D, Department of Medicine, Division of Nephrology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland.
Abstract
BACKGROUND: Although longer pretransplant dialysis has been associated with poor kidney transplant outcome, no data about this association exist from the current era or from Europe. We studied the association of pretransplant dialysis duration on outcomes after kidney transplantation across two different time periods. METHODS: All recipients of first kidney transplantation between 1990 and 2010 in Finland were included (N=3,105) in this observational follow-up study of an inception cohort. The association of the duration of pretransplant dialysis with patient and graft survival after transplantation was analyzed with multivariable Cox regression and competing risk analyses. The association of pretransplant dialysis duration with the risk of specific causes of death (cardiovascular, infectious, or other) was analyzed using competing risk analysis. RESULTS: Longer duration of pretransplant dialysis was an independent risk factor for patient death after transplantation (risk ratio [RR] 1.14 per 1-year increase) in the whole study population, but not for graft loss. Risk of death was increased in patients with greater than 12 months of pretransplant dialysis. After further adjustment in patients transplanted in 2000 to 2010, longer duration of dialysis remained an independent risk factor (RR 1.23 per 1-year increase). Longer duration of dialysis was an independent predictor of death resulting from cardiovascular diseases (RR 1.14 per 1-year increase), but not for other causes. CONCLUSIONS: The risk of death associated with longer duration of dialysis has not decreased over time, but remains an independent predictor of patient death after kidney transplantation because of increased risk of death resulting from cardiovascular diseases.
BACKGROUND: Although longer pretransplant dialysis has been associated with poor kidney transplant outcome, no data about this association exist from the current era or from Europe. We studied the association of pretransplant dialysis duration on outcomes after kidney transplantation across two different time periods. METHODS: All recipients of first kidney transplantation between 1990 and 2010 in Finland were included (N=3,105) in this observational follow-up study of an inception cohort. The association of the duration of pretransplant dialysis with patient and graft survival after transplantation was analyzed with multivariable Cox regression and competing risk analyses. The association of pretransplant dialysis duration with the risk of specific causes of death (cardiovascular, infectious, or other) was analyzed using competing risk analysis. RESULTS: Longer duration of pretransplant dialysis was an independent risk factor for patientdeath after transplantation (risk ratio [RR] 1.14 per 1-year increase) in the whole study population, but not for graft loss. Risk of death was increased in patients with greater than 12 months of pretransplant dialysis. After further adjustment in patients transplanted in 2000 to 2010, longer duration of dialysis remained an independent risk factor (RR 1.23 per 1-year increase). Longer duration of dialysis was an independent predictor of death resulting from cardiovascular diseases (RR 1.14 per 1-year increase), but not for other causes. CONCLUSIONS: The risk of death associated with longer duration of dialysis has not decreased over time, but remains an independent predictor of patientdeath after kidney transplantation because of increased risk of death resulting from cardiovascular diseases.
Authors: David D Aufhauser; Allison W Peng; Douglas R Murken; Seth J Concors; Peter L Abt; Deirdre Sawinski; Roy D Bloom; Peter P Reese; Matthew H Levine Journal: Clin Transplant Date: 2018-06-25 Impact factor: 2.863
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