A Dębska-Ślizień1, A Bobkowska-Macuk2, B Bzoma2, G Moszkowska3, A Milecka4, D Zadrożny4, W Wołyniec5, A Chamienia6, M Lichodziejewska-Niemierko7, E Król2, Z Śledziński4, B Rutkowski2. 1. Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland. Electronic address: adeb@gumed.edu.pl. 2. Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland. 3. Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland. 4. Department of General, Endocrine, and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland. 5. Department of Occupational, Metabolic and Internal Medicine, Medical University of Gdansk, Gdansk, Poland. 6. Kidney Transplant Regional Waiting List, Medical University of Gdansk, Gdansk, Poland; Department of General Nursing, Faculty of Medical Sciences, Medical University of Gdansk, Gdansk, Poland. 7. Department of Palliative Medicine, Medical University of Gdansk, Gdansk, Poland.
Abstract
BACKGROUND: The impact of dialysis modality before kidney transplantation (hemodialysis or peritoneal dialysis) on outcomes is not clear. In this study we retrospectively analyzed the impact of dialysis modality on posttransplant follow-up. METHODS: To minimize donor bias, a paired kidney analysis was applied. One hundred thirty-three pairs of peritoneal dialysis (PD) and hemodialysis (HD) patients were transplanted at our center between 1994 and 2016. Those who received kidneys from the same donor were included in the study. HD patients were significantly older (44 vs 48 years), but the Charlson Comorbidity Index was similar (3.12 vs 3.46) in both groups. The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.96 vs 2.95). RESULTS: One-year patient (98% vs 96%) and graft (90% vs 93%) survival was similar in the PD and HD patient groups. The Kaplan-Meier curves of the patients and graft survival did not differ significantly. Delayed graft function (DGF) and acute rejection (AR) occurred significantly more often in the HD recipients. Graft vessel thrombosis resulting in graft loss occurred in 9 PD (6.7%) and 4 HD (3%) patients (P > .05). Serum creatinine concentration and estimated glomerular filtration rate (using the Modification of Diet in Renal Disease guidelines) showed no difference at 1 month, 1 year, and at final visit. On multivariate analysis, factors significantly associated with graft loss were graft vessel thrombosis, DGF, and graft function 1 month after transplantation. On univariate analysis, age, coronary heart disease, and graft loss were associated with death. Among these factors, only coronary heart disease (model 1) and graft loss were significant predictors of death on multivariate analysis. CONCLUSION: The long-term outcome for renal transplantation is similar in patients with PD and HD. These groups differ in some aspects, however, such as susceptibility to vascular thrombosis in PD patients, and to DGF and AR in HD patients.
BACKGROUND: The impact of dialysis modality before kidney transplantation (hemodialysis or peritoneal dialysis) on outcomes is not clear. In this study we retrospectively analyzed the impact of dialysis modality on posttransplant follow-up. METHODS: To minimize donor bias, a paired kidney analysis was applied. One hundred thirty-three pairs of peritoneal dialysis (PD) and hemodialysis (HD) patients were transplanted at our center between 1994 and 2016. Those who received kidneys from the same donor were included in the study. HDpatients were significantly older (44 vs 48 years), but the Charlson Comorbidity Index was similar (3.12 vs 3.46) in both groups. The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.96 vs 2.95). RESULTS: One-year patient (98% vs 96%) and graft (90% vs 93%) survival was similar in the PD and HDpatient groups. The Kaplan-Meier curves of the patients and graft survival did not differ significantly. Delayed graft function (DGF) and acute rejection (AR) occurred significantly more often in the HD recipients. Graft vessel thrombosis resulting in graft loss occurred in 9 PD (6.7%) and 4 HD (3%) patients (P > .05). Serum creatinine concentration and estimated glomerular filtration rate (using the Modification of Diet in Renal Disease guidelines) showed no difference at 1 month, 1 year, and at final visit. On multivariate analysis, factors significantly associated with graft loss were graft vessel thrombosis, DGF, and graft function 1 month after transplantation. On univariate analysis, age, coronary heart disease, and graft loss were associated with death. Among these factors, only coronary heart disease (model 1) and graft loss were significant predictors of death on multivariate analysis. CONCLUSION: The long-term outcome for renal transplantation is similar in patients with PD and HD. These groups differ in some aspects, however, such as susceptibility to vascular thrombosis in PDpatients, and to DGF and AR in HDpatients.
Authors: Ali I Gardezi; Brenda Muth; Adil Ghaffar; Fahad Aziz; Neetika Garg; Maha Mohamed; David Foley; Dixon Kaufman; Arjang Djamali; Didier Mandelbrot; Sandesh Parajuli Journal: Kidney Int Rep Date: 2021-04-17