Preemptive transplantation and long-term outcome in living donor kidney transplantation, single-center experience.
Although preemptive transplantation of kidneys from living donors without the previous initiation of dialysis is associated with longer allograft survival in a USRDS cohort, the effect of pretransplantation dialysis on graft outcome is still controversial in Korea. The purpose of this study was to evaluate the differential effects on long-term outcomes of living donor kidney transplantation according to initiation of dialysis and its duration or no dialysis. We performed a retrospective cohort study of 494 patients who received a first kidney transplant from a living donor between 1990 and 2006. The mean duration for dialysis was 14.5+/-22.2 months. The 10-year patient survival of 98.0% in the preemptive group was not significantly higher than the dialysis group (91.2%, P>.05). However, 10-year graft survival was higher in the preemptive than the dialysis group (preemptive 94.4%, dialysis 76.5%; P<.05). The differential effect of pretransplant dialysis either by hemodialysis or peritoneal dialysis was not significant, although peritoneal dialysis as a pretransplant treatment seemed to be beneficial on long-term graft survival (5-year graft survival; peritoneal 94.8% and hemodialysis 89.2%). The duration of dialysis did not affect graft survival in our study cohort. In conclusion, we suggest that preemptive transplantation should be applied to eligible patients.
Joo
K W
KW
Seoul National University College of Medicine, Seoul, South Korea.
Shin
S J
SJ
Lee
S H
SH
Ha
J W
JW
Kim
S
S
Kim
Y S
YS
D000293:Adolescent; D000328:Adult; D000368:Aged; D003241:Consanguinity; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome