Gauri Bhutani1, Brad C Astor1,2, Didier A Mandelbrot1, Lori Mankowski-Gettle3, Timothy Ziemlewicz3, Shane A Wells3, Leah Frater-Rubsam4, Vanessa Horner4,5, Courtney Boyer1, Jennifer Laffin6, Arjang Djamali1,7. 1. Division of Nephrology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin. 2. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin. 3. Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin. 4. Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, Wisconsin. 5. Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin. 6. Department of Pediatrics, University of Wisconsin, Madison, Wisconsin. 7. Division of Transplant Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
Abstract
Background: Polycystic kidney disease (PKD) accounts for approximately 15% of kidney transplants, but long-term outcomes in patients with PKD who have received a kidney transplant are not well understood. Methods: In primary recipients of kidney transplants at our center (1994-2014), we compared outcomes of underlying PKD (N=619) with other native diseases (non-PKD, N=4312). Potential factors influencing outcomes in PKD were evaluated using Cox proportional-hazards regression and a rigorous multivariable model. Results: Patients with PKD were older and were less likely to be sensitized or to experience delayed graft function (DGF). Over a median follow-up of 5.6 years, 1256 of all recipients experienced death-censored graft failure (DCGF; 115 patients with PKD) and 1617 died (154 patients with PKD). After adjustment for demographic, dialysis, comorbid disease, surgical, and immunologic variables, patients with PKD had a lower risk of DCGF (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.57 to 0.93; P=0.01) and death (aHR, 0.62; 95% CI, 0.51 to 0.75; P<0.001). In our multiadjusted model, calcineurin-inhibitor (CNI) use was associated with lower risk of DCGF (aHR, 0.45; 95% CI, 0.26 to 0.76; P=0.003), whereas HLA mismatch of five to six antigens (aHR, 2.1; 95% CI, 1.2 to 3.64; P=0.009) was associated with higher likelihood of DCGF. Notably, both pretransplant coronary artery disease (CAD) and higher BMI were associated with increased risk of death (CAD, aHR, 2.5; 95% CI, 1.69 to 3.71; P<0.001; per 1 kg/m2 higher BMI, aHR, 1.07; 95% CI, 1.04 to 1.11; P<0.001), DCGF, and acute rejection. Nephrectomy at time of transplant and polycystic liver disease were not associated with DCGF/death. Incidence of post-transplant diabetes mellitus was similar between PKD and non-PKD cohorts. Conclusions: Recipients with PKD have better long-term graft and patient survival than those with non-PKD. Standard practices of CNI use and promoting HLA match are beneficial in PKD and should continue to be promoted. Further prospective studies investigating the potential benefits of CNI use and medical/surgical interventions to address CAD and the immunologic challenges of obesity are needed. Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2021_02_25_KID0001182019.mp3.
Background: Polycystic kidney disease (PKD) accounts for approximately 15% of kidney transplants, but long-term outcomes in patients with PKD who have received a kidney transplant are not well understood. Methods: In primary recipients of kidney transplants at our center (1994-2014), we compared outcomes of underlying PKD (N=619) with other native diseases (non-PKD, N=4312). Potential factors influencing outcomes in PKD were evaluated using Cox proportional-hazards regression and a rigorous multivariable model. Results: Patients with PKD were older and were less likely to be sensitized or to experience delayed graft function (DGF). Over a median follow-up of 5.6 years, 1256 of all recipients experienced death-censored graft failure (DCGF; 115 patients with PKD) and 1617 died (154 patients with PKD). After adjustment for demographic, dialysis, comorbid disease, surgical, and immunologic variables, patients with PKD had a lower risk of DCGF (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.57 to 0.93; P=0.01) and death (aHR, 0.62; 95% CI, 0.51 to 0.75; P<0.001). In our multiadjusted model, calcineurin-inhibitor (CNI) use was associated with lower risk of DCGF (aHR, 0.45; 95% CI, 0.26 to 0.76; P=0.003), whereas HLA mismatch of five to six antigens (aHR, 2.1; 95% CI, 1.2 to 3.64; P=0.009) was associated with higher likelihood of DCGF. Notably, both pretransplant coronary artery disease (CAD) and higher BMI were associated with increased risk of death (CAD, aHR, 2.5; 95% CI, 1.69 to 3.71; P<0.001; per 1 kg/m2 higher BMI, aHR, 1.07; 95% CI, 1.04 to 1.11; P<0.001), DCGF, and acute rejection. Nephrectomy at time of transplant and polycystic liver disease were not associated with DCGF/death. Incidence of post-transplant diabetes mellitus was similar between PKD and non-PKD cohorts. Conclusions: Recipients with PKD have better long-term graft and patient survival than those with non-PKD. Standard practices of CNI use and promoting HLA match are beneficial in PKD and should continue to be promoted. Further prospective studies investigating the potential benefits of CNI use and medical/surgical interventions to address CAD and the immunologic challenges of obesity are needed. Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2021_02_25_KID0001182019.mp3.
Authors: Y Shiroyanagi; K Tanabe; Y Hashimoto; H Okuda; T Oshima; T Tokumoto; N Ishikawa; H Tomq Journal: Transplant Proc Date: 2000-11 Impact factor: 1.066
Authors: H U Meier-Kriesche; A O Ojo; S F Leavey; J A Hanson; A B Leichtman; J C Magee; D M Cibrik; B Kaplan Journal: Transplantation Date: 2001-02-15 Impact factor: 4.939
Authors: S Katznelson; A H Wilkinson; J A Kobashigawa; X M Wang; D Chia; M Ozawa; H P Zhong; M Hirata; A H Cohen; P I Teraski Journal: Transplantation Date: 1996-05-27 Impact factor: 4.939
Authors: David P Foley; Pamela R Patton; Herwig-Ulf Meier-Kriesche; Qin Li; Betsy Shenkman; Shiro Fujita; Alan Reed; Alan W Hemming; Robin D Kim; Richard J Howard Journal: Clin Transpl Date: 2005
Authors: Jamshid Roozbeh; Ali Reza Razmkon; Hamed Jalaeian; Ganbar Ali Raiss-Jalali; Saeed Behzadi; Mohammad Mehdi Sagheb; Heshmatollah Salahi; Ali Bahador; Saman Nikeghbalian; Hamid Reza Davari; Mehdi Salehipour; Seyed Ali Malek-Hosseini Journal: Saudi J Kidney Dis Transpl Date: 2008-01