Association of Dialysis Duration With Outcomes After Kidney Transplantation in the Setting of Long Cold Ischemia Time

Abstract

BackgroundThere is no mechanism that matches hard-to-place kidneys with the most appropriate candidate. Thus, unwanted kidney offers are typically to recipients with long renal replacement time (vintage) which is a strong risk factor for mortality and graft failure, and in combination with prolonged cold ischemia time (CIT), may promote interactive effects on outcomes.MethodsConsecutive adult isolated kidney transplants between October 2015 and December 2017 were stratified by vintage younger than 1 year and CIT longer than 30 hours.ResultsLong (n = 169) relative to short (n = 93) vintage recipients were significantly more likely to be younger (32.2 years vs 56.9 years, P = 0.02), black race (40.8% vs 18.3%, P = 0.02), have higher estimated posttransplant survival (52.6 vs 42.0, P = 0.04), and have a comorbid condition (45.6% vs 30.1%, P = 0.02); they were less likely to receive a donation after circulatory death kidney (27.8% vs 39.8%, P = 0.05). Long vintage was significantly associated with length of stay longer than 4 days (45.5% vs 30.1%, P = 0.02), and 30-day readmission (37.3% vs 22.6%, P = 0.02) but not additional operations (17.8% vs 15.1%, P = 0.58), short-term patient mortality (3.0% vs 2.2%, P = 0.70), or overall graft survival (P = 0.23). On multivariate logistic regression, long vintage remained an independent risk factor for 30-day readmission (adjusted odds ratio, 1.92; 95% confidence interval, 1.06-3.47); however, there was no interaction of vintage and CIT for this outcome (P = 0.84).ConclusionsReadmission is significantly associated with pretransplant dialysis duration; however, CIT is not a modifying factor for this outcome.

Pre‐transplant maintenance dialysis duration and outcomes after kidney transplantation: A multicenter population‐based cohort study

“…Notably, in our primary analysis we found pre‐emptive transplantation was only associated with a significantly reduced rate of total graft failure but had no notable associations with our other outcomes. Similar to other recently published studies, 9,18 our findings suggest that the benefits of pre‐emptive kidney transplant in a contemporary cohort may not be as substantial as previously reported. The reduced beneficial effect of pre‐emptive kidney transplantation is plausible due to improvements in the care of the transplant and dialysis populations 34,35 .…”

“…Several studies have examined the impact of dialysis duration on post‐transplant outcomes, with many studies finding a longer time on dialysis is associated with decreased graft and patient survival (Supplementary material, Appendix S1). 2,7,16–23,8–15 However, conflicting results have been found on the association between dialysis duration and death‐censored graft survival, with more recent studies finding no association 2,9,15 . There are some notable limitations in the literature.…”

Estudo das Crenças de Receptores acerca do Transplante Renal - Estudo Qualitativo

“…Preocupações relacionadas à perda do enxerto e às incertezas quanto aos desfechos clínicos são fontes de ansiedade para os participantes, conforme relatados também por outros autores (Been-Dahmen et al, 2018;Lonning et al, 2018;Yaman & Yılmaz, 2017). Recentemente, pesquisadores têm se ocupado de investigações acerca da compreensão da relação entre os aspectos clínicos e a perda do enxerto e de diferenças nos desfechos entre receptores (Bonner et al, 2019;Haller et al, 2019;Kosola et al, 2019;Pestana, 2017;Sharma et al, 2019;Vinson et al, 2019). Essas preocupações são reflexo da apreensão acerca das altas taxas de prevalência para a não aderência ao tratamento após o transplante (Brahm, 2012;Maissiat et al, 2013;Marsicano, 2012;Silva, 2015).…”

Dynamic changes of neutrophil-to-lymphocyte ratio in brain-dead donors and delayed graft function in kidney transplant recipients

“…Currently, the most accepted definition of DGF is the requirement of at least one dialysis during the first week following transplantation [ 1–3 ]. The development of DGF prolongs the hospital’s stay and contributes to a 40% chance of graft failure in the first year after transplantation [ 4 , 5 ]. Accumulating evidence indicates that ischemia/reperfusion injury plays a vital role in the mechanism underlying DGF [ 2 , 6–8 ].…”