Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients.
BACKGROUND
A substantial number of patients return to dialysis therapy after a renal transplant fails. It is not clear whether mortality increases among patients with graft failure relative to those on the waiting list who have not yet received a kidney transplant.


METHODS
Data from the Scientific Registry of Transplant Recipients were analyzed (N = 175,436). Cox regression with time-dependent covariates was used to compare mortality between post-graft failure dialysis patients and primary transplant candidates on dialysis therapy. Mortality hazard ratios (HRs) were adjusted for age, sex, race, cause of end-stage renal disease, pre-waiting list time on dialysis therapy, calendar year of wait-listing, and organ procurement organization.


RESULTS
Overall, the post-graft failure dialysis group experienced a significant 78% greater mortality (HR, 1.78; P < 0.0001) relative to the transplant candidate group. The post-graft failure dialysis/transplant candidate HR was relatively constant across age groups, but significantly greater (P < 0.0001) among patients with diabetes (HR, 1.93) than among those without diabetes (HR, 1.69). The HR was greatest during the first week after graft failure (HR, 13.6; P < 0.0001) and decreased steadily thereafter. However, despite leveling off, the HR remained significantly elevated well after graft failure, including the 5- to 10-year period after graft failure.


CONCLUSIONS
Based on national data, mortality among patients on dialysis therapy after primary graft failure increases significantly relative to mortality among patients still awaiting primary kidney transplantation. Additional studies are urgently needed to define the mechanism of the increased risk and strategies to decrease mortality.
Rao
Panduranga S
PS
Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI 48103, USA. spandu@umich.edu
Schaubel
Douglas E
DE
Jia
Xiaoyu
X
Li
Shiqian
S
Port
Friedrich K
FK
Saran
Rajiv
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality* / Q000639:trends; D015996:Survival Rate / Q000639:trends