Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

Abstract

Background and objectives Evidence regarding the differences in clinical outcomes after preemptive kidney transplantation (PKT) and non-PKT in Japan is lacking.Design, setting, participants, & measurements We conducted a retrospective cohort study at a single center in Japan. Consecutive patients ages .18 years old who had received a kidney transplant from a living donor between November of 2001 and December of 2013 at our institution (n=786) were enrolled. The primary study outcome was the occurrence of clinical events before the end of 2014. Clinical events were defined as any of the following: death with functioning graft (DWFG), graft loss, or post-transplant cardiovascular disease (CVD).Results The median follow-up period was 61.0 (35.3-94.0) months. PKT was performed in 239 patients (30.4%). Clinical events occurred in 78 (9.9%). In the Cox proportional hazard model for univariate analysis, factors found to be associated with higher risk of clinical events included older age, men, ABO incompatibility, longer dialysis duration, diabetes, pretransplant CVD, and large ventricular mass index. PKT was associated with lower risk. Clinical event rate in patients who received a PKT was 3.3% compared with 10.8%, 11.1%, 10.4%, 10.2%, 16.7%, and 16.2% among patients who were on dialysis for ,1, 1 to ,2, 2 to ,3, 3 to ,4, 4 to ,5, and $5 years before transplant, respectively (P=0.002). The multivariate analysis showed that ABO incompatibility (hazard ratio [HR], 2.98; 95% confidence interval [95% CI], 1.89 to 4.71), duration of dialysis per year (HR, 1.07; 95% CI, 1.03 to 1.11), and diabetes (HR, 3.54; 95% CI, 2.05 to 6.12) were only three independent risk factors for the incidence of clinical events.Conclusions Even in Japan, where the long-term outcomes of patients on hemodialysis are excellent, PKT could be beneficial to reduce DWFG, graft loss, and post-transplant CVD.

Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases

“…Since renal transplant recipients have less time restrictions than dialysis patients and suffer less from uremia, renal transplantation is considered the optimal treatment for social rehabilitation. Especially, preemptive kidney transplantation (PEKT) without long-term dialysis is recommended as advantageous not only for the prevention of sarcopenia/frailty but also for improving the vital prognosis [98] and QOL [99]. From these viewpoints, also, renal transplantation may be the utmost means for renal rehabilitation.…”

Frailty is associated with dialysis duration before transplantation in kidney transplant recipients: A Japanese single‐center cross‐sectional study

“…25 Pre-emptive kidney transplantation reduces death, graft loss and post-transplant CVD. 26 Preemptive kidney transplantation might, therefore, be an optimal renal replacement therapy for patients with end-stage kidney disease to avoid frailty and achieve longer healthy life expectancy after kidney transplantation. The KCL was developed by the Japanese Ministry of Health, Labor and Welfare to identify older persons who would be at risk for requiring care or support in the near future.…”

Successful pre-emptive kidney transplantation in a cystinuria patient with nephrolithiasis-related end-stage renal disease

“…According to recent studies, pre-emptive transplantation has many benefits, including improved patient and graft survival, and a less delayed graft function in comparison to transplantation after dialysis [10]. Other outcomes are improved, including a reduced overall cost of care, and improved patient employment status [11].…”

“…4 MRA coronal image of a transplanted kidney. Renal artery anastomosis to the left external iliac artery showed no anastomotic stenosis NA not available, DDKT deceased donor kidney transplantation, LDKT living donor kidney transplantation, POD post-operative days living donors has increased year by year and reached approximately 25.5% in 2013 [10,12].…”