title: Dialysis prior to living donor kidney transplantation and rates of acute rejection.
abstract: BACKGROUND
  The relationship between transplantation prior to chronic dialysis initiation and the pattern of acute rejection of kidneys from living donors (LDKT) has not been fully explored.
  
  
  METHODS
  Using data provided by the United States Renal Data System, we performed a retrospective cohort study fitting multivariate proportional hazards models to characterize the association of chronic use of dialysis prior to transplantation [non-pre-emptive LDKT (non-PLDKT)] and acute rejection, and to examine if this association varies throughout the first year.
  
  
  RESULTS
  Non-PLDKT was associated with a 2.5-fold higher rate of biopsy-confirmed rejection during the first month [adjusted HR 2.5, 95% confidence interval (1.85-3.33)], compared with no dialysis prior to transplantation. Increasing duration of pre-transplant dialysis was associated with increasing rate of biopsy-confirmed acute rejection during the first month (P = 0.001 for trend). Over the first year, there was a diminishing relationship between non-PLDKT and acute rejection: 2.5-, 2.22-, 2.13- and 1.78-fold elevation in the episodes of biopsy-confirmed acute rejection during the first, second, third through to the sixth and seventh through to the twelfth month post-transplant, respectively (P = 0.05 for trend).
  
  
  CONCLUSIONS
  The waning of the association of non-PLDKT with acute rejection over time supports the hypothesis that dialysis exposure prior to transplantation may modulate the immune system to increase the rates of acute rejection.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA. kmange@cceb.med.upenn.edu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Mange
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000502:physiology; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D016016:Proportional Hazards Models; D044469:Racial Groups; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States