Effect of kidney replacement therapy modality after first kidney graft failure on second kidney transplantation outcomes

Abstract

Background There is lack of information regarding which is the best dialysis technique after kidney transplant (KT) failure. The aim of this study is to compare the effect of kidney replacement therapy modality -peritoneal dialysis (TX-PD-TX), hemodialysis (TX-HD-TX) and preemptive deceased donor retransplantation (TX-TX)- on patient survival and second KT outcomes. Methods A retrospective observational study from the Catalan Renal Registry was carried out. We included adult patients with failing of their first KT from 2000 to 2018. Results Among 2,045 patients, 1,829 started on HD (89.4%), 168 on PD (8.2%) and 48 (2.4%) received a preemptive KT. Non-inclusion in the KT waiting list and HD were associated with worse patient survival. For patients included in the waiting list, the probability of HLA sensitization and to receive a second KT was similar in HD and PD. 776 patients received a second KT (38%), 656 in TX-HD-TX, 72 in TX-PD-TX and 48 in TX-TX groups. Adjusted mortality after second KT was higher in TX-HD-TX patients compared with TX-TX and TX-PD-TX groups, without differences between TX-TX and TX-PD-TX group. Death-censored second graft survival was similar in all 3 groups. Conclusions Our results suggest that after first KT failure, PD is superior to HD in reducing mortality in candidates for a second KT without options for preemptive retransplantation.

Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss

“…A prior cohort study of patients with failed first allografts showed that patients reinitiated on dialysis and on the waitlist for repeat transplantation post-allograft loss had superior survival compared to patients reinitiated on dialysis but not waitlisted, likely reflecting differences in patient characteristics and comorbid burden [ 26 ]. Similarly, our study has shown that patients who were waitlisted for repeat transplantation following first allograft loss had significantly lower risk of all-cause mortality compared to patients who were not waitlisted, with this survival advantage observed for those with or without diabetes.…”

Peritoneal dialysis discontinuation: to the root of the problem

“…A growing body of evidence indicates that patients on PD have comparable (or better) clinical outcomes and quality of life as patients on HD [ 2 , 4 , 5 , 7 , 28 ]. In addition, PD is generally less expensive than HD, making this RRT a cost-effective option for ESKD patients.…”

“…Large observational studies indicate a survival advantage of PD for the initial 2–3 years of therapy, with subsequent loss of this benefit or later advantage to HD. Moreover, PD may offer some advantages over HD with regard to quality of life and kidney transplantation outcome [ 4 , 5 ] and costs savings [ 1 ]. Ideally, the individual choice for the most appropriate dialysis modality should be made following an evidence-based approach considering patient characteristics and needs, current and future options for renal replacement therapy (RRT), and patient preferences.…”