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. 2022 Feb 17;11(4):1054.
doi: 10.3390/jcm11041054.

Impact of the Type of Dialysis on Time to Transplantation: Is It Just a Matter of Immunity?

Matteo Righini  1   2 , Irene Capelli  1 , Marco Busutti  1 , Concettina Raimondi  1 , Giorgia Comai  1 , Gabriele Donati  1 , Maria Laura Cappuccilli  3 , Matteo Ravaioli  4 , Pasquale Chieco  3 , Gaetano La Manna  1
Affiliations

Impact of the Type of Dialysis on Time to Transplantation: Is It Just a Matter of Immunity?

Matteo Righini et al. J Clin Med. .

Abstract

Background: Renal transplantation represents the therapeutic gold standard in patients with end stage renal disease (ESRD). Still the role of pre-transplant dialysis in affecting time to transplantation has yet to be determined. We wanted to verify whether the type of renal replacement therapy (hemodialysis vs. peritoneal dialysis) affects time to transplantation and to identify clinical features related to the longer time to transplantation.

Methods: We performed a retrospective single-center observational study on patients who had received a transplant in the Bologna Transplant Unit from 1991 to 2019, described through the analysis of digital transplant list documents for sex, age, body mass index (BMI), blood group, comorbidities, underlying disease, serology, type of dialysis, time to transplantation, Panel Reactive Antibodies (PRA) max, number of preformed anti Human Leukocyte Antigens (HLA) antibodies. A p-value < 0.05 was considered statistically significant.

Results: In the 1619 patients analyzed, we observed a significant difference in time to transplant, PRA max and Preformed Antibodies Number between patients who received Hemodialysis (HD) and Peritoneal dialysis (PD). Then we performed a multiple regression analysis with all the considered factors in order to identify features that support these differences. The clinical variables that independently and directly correlate with longer time to transplantation are PRA max (p < 0.0001), Antibodies number (p < 0.0001) and HD (p < 0.0001); though AB blood group (p < 0.0001), age (p < 0.003) and PD (p < 0.0001) inversely correlate with time to transplantation.

Conclusions: In our work, PD population received renal transplants in a shorter period of time compared to HD and turned out to be less immunized. Considering immunization, the type of dialysis impacts both on PRA max and on anti HLA antibodies.

Keywords: autoimmunity; hemodialysis; kidney transplantation; peritoneal dialysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patients who received a kidney transplant in Bologna Transplant Unit between 1991 and 2019 and exclusion criteria.
Figure 2
Figure 2
Patients divided according to PRA max. The classes were selected according to the study conducted by Bostock IC et al. [18]. HD: hemodialysis. PD: peritoneal dialysis.
Figure 3
Figure 3
Patients who received kidney transplant divided by type of dialysis. Those who received PD (271 patients) reached the goal (kidney transplant) far earlier than those who received HD (1347 patients) (Log-Rank ChiSquare 21.99, p < 0.0001, Wilcoxon ChiSquare 5.77, p = 0.0163).
See this image and copyright information in PMC

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