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. 2022 Oct 21;12(1):17614.
doi: 10.1038/s41598-022-20003-2.

Effect of pretransplant dialysis vintage on clinical outcomes in deceased donor kidney transplant

Jeong-Hoon Lim  1 , Yena Jeon  2 , Deok Gie Kim  3 , Yeong Hoon Kim  4 , Joong Kyung Kim  5 , Jaeseok Yang  6 , Myoung Soo Kim  7 , Hee-Yeon Jung  1 , Ji-Young Choi  1 , Sun-Hee Park  1 , Chan-Duck Kim  1 , Yong-Lim Kim  1 , Jang-Hee Cho  8 ; Korean Organ Transplantation Registry Study Group
Collaborators, Affiliations

Effect of pretransplant dialysis vintage on clinical outcomes in deceased donor kidney transplant

Jeong-Hoon Lim et al. Sci Rep. .

Abstract

The waiting time for deceased donor kidney transplants (DDKT) is increasing. We evaluated DDKT prognosis according to the pretransplant dialysis vintage. A total of 4117 first-time kidney transplant recipients were enrolled from a prospective nationwide cohort in Korea. DDKT recipients were divided into tertiles according to pretransplant dialysis duration. Graft failure, mortality, and composite were compared between DDKT and living donor kidney transplant (LDKT) recipients. Pretransplant dialysis vintage was longer annually in DDKT recipients. In the subdistribution of the hazard model for the competing risk, the first tertile did not show an increased risk of graft failure compared with LDKT recipients; however, the second and third tertile groups had an increased risk of graft failure compared to LDKT recipients (adjusted hazard ratio [aHR] 3.59; 95% confidence interval [CI] 1.69-7.63; P < 0.001; aHR 2.37; 95% CI 1.06-5.33; P = 0.037). All DDKT groups showed a significantly higher risk of patient death than LDKT, with the highest risk in the third tertile group (aHR 11.12; 95% CI 4.94-25.00; P < 0.001). A longer pretransplant dialysis period was associated with a higher risk of the composite of patient death and graft failure in DDKT recipients. DDKT after a short period of dialysis had non-inferior results on graft survival compared with LDKT.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Pretransplant dialysis vintage distribution and annual changes in deceased donor kidney transplant. LDKT living donor kidney transplant.
Figure 2
Figure 2
Kaplan–Meier curves for outcomes. (A) Composite outcome. (B) Patient survival. (C) Death-censored graft survival.
Figure 3
Figure 3
Cumulative incidence curves using the competing risk analysis method for graft failure stratified by duration of pretransplant dialysis. The Aalen–Johansen method was used for incidence estimate, and patient death was considered as a competing risk. LDKT living donor kidney transplant.
Figure 4
Figure 4
Subgroup competing risk analysis for graft failure. LDKT living donor kidney transplant, BMI body mass index, BPAR biopsy-proven acute rejection, DM diabetes mellitus, HR hazard ratio, CI confidence interval.
See this image and copyright information in PMC

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