The Role of Pretransplantation Renal Replacement Therapy Modality in Kidney Allograft and Recipient Survival

Goldfarb–Rumyantzev, Alexander S.; Hurdle, John F.; Scandling, John D.; Baird, Bradley C.; Cheung, Alfred K.

doi:10.1053/j.ajkd.2005.05.013

Cited by 88 publications

(87 citation statements)

References 33 publications

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“…These include demographic characteristics (20) such as race and ethnicity (21), pretransplantation dialysis course (17), and the timing of the transplantation (16). Patient response to the transplantation procedure (e.g., delayed graft function, acute rejection, acute tubular necrosis) is strongly associated with the long-term prognosis (22).…”

Section: Discussionmentioning

confidence: 99%

Role of Maintenance Immunosuppressive Regimen in Kidney Transplant Outcome

Goldfarb–Rumyantzev¹,

Smith²,

Shihab³

et al. 2006

Clinical Journal of the American Society of Nephrology

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Data of long-term immunosuppressive protocol comparison are lacking. The goal of this study was to compare kidney transplant outcome using three common immunosuppressive protocols. A retrospective study was performed of the graft and recipient survival using US Renal Data System data (n ‫؍‬ 31,012) between January 1, 1995, and December 31, 1999, with the follow-up through December 31, 2000, on prednisone ؉ cyclosporine ؉ mycophenolate mofetil (PCM; n ‫؍‬ 17,108), prednisone ؉ tacrolimus ؉ mycophenolate mofetil (PTM; n ‫؍‬ 7225), or prednisone ؉ cyclosporine ؉ azathioprine (PCA; n ‫؍‬ 6679). Compared with PCM, there is an increased risk for allograft failure associated with PTM (hazard ratio [HR] 1.09; P < 0.05) and PCA (HR 1.15; P < 0.001). Similar associations were demonstrated in the following subgroups: Early (before 1997) and late (in or after 1997) transplant periods, in living-donor transplants, and in adult and kidney-only recipients. This association also was found between PCA regimen and graft survival in the entire patient population (HR 1.15; P < 0.001) and in the studied subgroups. PCA (HR 1.15; P < 0.005), but not PTM (HR 1.01; P ‫؍‬ 0.816), regimen was associated with increased recipient mortality in the entire patient population and in patient subgroups. Secondary outcomes (serum creatinine values at given time points, acute rejection rate, and posttransplantation malignancies) are also discussed. These data suggest that a PCM regimen is associated with lower risk for graft failure compared with a PTM regimen and with lower risk for graft failure and recipient death compared with a PCA regimen.

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Section: Discussionmentioning

confidence: 99%

Role of Maintenance Immunosuppressive Regimen in Kidney Transplant Outcome

Goldfarb–Rumyantzev¹,

Smith²,

Shihab³

et al. 2006

Clinical Journal of the American Society of Nephrology

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“…The comorbidity score used in this study was calculated based on the following coexisting conditions, each of them contributing one point to the score: cardiovascular disease (defined in the USRDS as symptomatic cardiovascular disease or angina/coronary artery disease), symptomatic peripheral vascular disease, diabetes mellitus and hypertension. This indicator of comorbidity was successfully used in our prior studies [4,35]. Information about co-existing conditions was obtained from the TXUNOS file, based on the information collected from the Transplant Candidate Registration Form; therefore, the comorbidities used for this study are those that patients had at the time of listing for the study transplant.…”

Section: Independent Variablesmentioning

confidence: 99%

“…Both genetic [1,2] and environmental factors [3][4][5][6] were implicated in short-and long-term kidney allograft and recipient survival.…”

Section: Introductionmentioning

confidence: 99%

The outcome of renal transplantation among systemic lupus erythematosus patients

Chelamcharla

Javaid

Baird

et al. 2007

Nephrology Dialysis Transplantation

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Background. Clinical outcome of renal transplantation among systemic lupus erythematosus (SLE) patients remains a topic of controversy. Most of the previous reports were based upon small single-centre studies that were not always well-designed. Methods. We conducted the retrospective analysis using data from USRDS and UNOS databases. Patients were divided into five groups based on the cause of end-stage renal disease (ESRD): diabetes mellitus (DM), SLE, glomerulonephritis, hypertension and other causes. Between 1990 and 1999, 2886 renal transplantation recipients with ESRD due to SLE were identified from a total of 92 844 patients. Results. The mean follow-up period of this study was 4.7 AE 2.4 years. While unadjusted analysis using Kaplan-Meier curves demonstrated an association between SLE and improved allograft survival compared with DM, in multivariate analysis the SLE group had worse allograft [hazard ratio (HR) 1.09, P < 0.05] and recipient (HR 1.19, P < 0.05) survival compared with the DM group. Subgroup analysis based on the type of donor showed that SLE patients who received deceased donor allograft had worse allograft and recipient survival (HR 1.14, P ¼ 0.002 and HR 1.30, P ¼ 0.001, respectively) compared with non-SLE deceased donor allograft recipients. Among living allograft recipients, there were no significant differences in either allograft or recipient survival compared with non-SLE recipients. Conclusions. SLE as a cause of ESRD in renal transplant recipients is associated with worse allograft and recipient survival compared with DM; this association is true for the entire population and for the recipients of deceased donor (but not living donor) transplant. Deceased donor allograft recipients have worse outcomes compared with living allograft recipients.

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“…Multiple retrospective cohort observational studies suggested that, if transplanted from PD, one was less likely to have delayed graft function and therefore would be likely to have longer graft survival. A more recent study from the United States suggested that patients transplanted from PD (or if at least 50% of their pretransplant RRT time was on PD) had a 6% lower risk of death and a 3% lower risk of graft failure than those transplanted from CHD (19). Given our goal to improve transplant rates and the transition from dialysis (PD or HD) to transplant, this would suggest that the future of PD is bright, and PD should be considered more often.…”

Section: Review Of Medical Outcome Datamentioning

confidence: 99%

The Future of Peritoneal Dialysis in the United States

Burkart

2009

Clinical Journal of the American Society of Nephrology

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Peritoneal dialysis (PD) has been used to treat patients with stage V chronic kidney disease since 1976. However, despite this long history, as of 2008 <8% of prevalent ESRD patients in the United States are treated with PD, a modality mix that is significantly different from what is seen in other developed countries. Data are reviewed that suggest that the reasons for this seem to be caused by non-medical-related issues such as subtle differences in practice patterns and unintended financial considerations. Medical outcome date would seem to favor more utilization of PD. For instance, data from the USRDS suggested that the relative risk of death for PD versus center hemodialysis has been improving, tending to favor those on PD for longer and longer periods of time. Infectious complications have also been markedly reduced. It is anticipated that changes in government reimbursement, such as the bundling of dialysis-related services, will stimulate a renewed interest in home therapies. Currently most home dialysis units are small, and some have minimal clinical experience with PD. If trends in reimbursement do favor a renewed interest in PD, for patient outcomes on PD to continue to improve, there will likely need to be further educational activities focused on PD, and perhaps, consolidation of PD programs may needed.Clin J Am Soc Nephrol 4: S125-S131, 2009. doi: 10.2215/CJN.04760709 P eritoneal dialysis (PD) has been used as a chronic treatment for patients with ESRD since 1976 (1). Although the first patient to be treated with chronic ambulatory PD (CAPD) lived in Austin, TX, as of 2008, Ͻ8% of prevalent patients with ESRD in the United States are on PD, which is markedly different from the experience in other developed countries such as Mexico, Canada, New Zealand, Australia, and Hong Kong (2). Why is this, and given the current modality mix in the United States, what is the future for PD in terms of patient outcomes, utilization, and technological advances? I became an attending nephrologist in 1984, and I have treated many patients with PD, some for Ͼ15 yr. We have a robust center hemodialysis (CHD) and a robust home dialysis unit (both PD and home hemodialysis [HHD]), our patients do well, and I am the medical director of that unit. It would be fair to say that I am biased toward home dialysis and toward PD in general. It is based on these experiences and my review of the literature that I feel that PD has a future; it is currently underused; and that, over time, patient outcomes on PD should improve even further. Materials and MethodsAs part of the "State of the art in ESRD" therapies conference, I was asked to prepare and present a talk that commented on the future of PD in the United States. Specifically, I was asked to be provocative and state what is the difference between what happens in the United States and other countries. I was asked to review published data and formulate opinions as to how PD use could grow if clinically appropriate. This paper is a summary of my presentation. Review of Medical Ou...

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The Role of Pretransplantation Renal Replacement Therapy Modality in Kidney Allograft and Recipient Survival

Cited by 88 publications

References 33 publications

Role of Maintenance Immunosuppressive Regimen in Kidney Transplant Outcome

Role of Maintenance Immunosuppressive Regimen in Kidney Transplant Outcome

The outcome of renal transplantation among systemic lupus erythematosus patients

The Future of Peritoneal Dialysis in the United States

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