Variation in Dialysis Exposure Prior to Nonpreemptive Living Donor Kidney Transplantation in the United States and Its Association With Allograft Outcomes

The association of pretransplant dialysis exposure with transplant failure is dependent on the state-specific rate of dialysis mortality

“…This analysis included adult patients, aged 18‐70 years, who initiated maintenance dialysis on or after May 1, 1995, and underwent a deceased donor kidney‐only transplant on or before December 31, 2012. Living donor transplant recipients were excluded from the study because most living donor transplants are performed within 2 years of dialysis initiation in the United States 18 . The start date was chosen to ensure all patients had a Centers for Medicare and Medicaid Services Form 2728, also known as the Medevid form, which contains information about comorbid conditions known to impact posttransplant outcomes.…”

The Causes of Kidney Allograft Failure: More Than Alloimmunity. A Viewpoint Article

“…8 Other pretransplant risk factors include diabetes mellitus, cardiovascular disease, patient functional status and the extent of dialysis exposure. 9,10 The causes of death vary by recipient age group 11 but the main causes of death are cardiovascular disease, malignancies and infections, all of which are also influenced by posttransplant variables, such as the use of immunosuppressive agents. The increased cardiovascular risk is influenced both by immunosuppressants with side effects like diabetes, hypertension, dyslipidemia and by the direct impact of impaired kidney function.…”

Briefly Noted

“…found that the adjusted risk of transplant failure was 1.16-and 1.60-fold higher for patients with pretransplant dialysis times of 6.1-9.0 months and >60 months, respectively, compared to patients on dialysis for <3 months before transplantation. 15 A retrospective review of 100 pregnancies (in 84 women) from 1985 to 2015 in France found a 78% fetal survival and high rates of preeclampsia (19%), hydramnios (42%), and low birth weight (45%).…”

“…Data from 77 607 living donor transplants to patients on dialysis found that the adjusted risk of transplant failure was 1.16‐ and 1.60‐fold higher for patients with pretransplant dialysis times of 6.1‐9.0 months and >60 months, respectively, compared to patients on dialysis for <3 months before transplantation …”