[Failed transplant patients: dialysis initiation and short-term outcome].
This study was carried out to evaluate dialysis initiation of failed transplant patient and the short-term outcome of these patients on dialysis.


METHODS
We conducted a retrospective study of transplanted patients from one centre returning in dialysis after allograft failure. Those patients were transplanted between 31st October 1986 and 3rd March 2004. Patients who experienced allograft failure after 6 months on transplantation were included in the study.


RESULTS
Among 600 transplanted patients, 92 patients restarted dialysis after allograft failure. Of the 92 failed transplant patients, 69 had a graft survival of more than 6 months. The mean glomerular filtration rate at dialysis initiation was 13+/-5mL per minute. At time of dialysis initiation, patients had mean haemoglobin level at 80.7+/-10.7g/L, and mean serum albumin level at 34+/-6g/L. Urgent dialysis was needed for 39 over 57 patients. Fourteen over 58 patients had no vascular access or peritoneal catheter at dialysis initiation. Fifty-six over 69 patients were treated by haemodialysis. Of the 13 patients treated by peritoneal dialysis 7 were on PD before transplantation whereas 49 over 57 haemodialysis patients were treated by haemodialysis before transplant failure (p<0.05). Immunosuppressive therapy was stopped during the first year following transplantation failure in 52 over 69 patients and 36 over 69 patients underwent transplantectomy. Thirteen over 56 patients presented a least one cardiovascular events after transplantation failure.


CONCLUSIONS
Unplanned dialysis initiation is frequent in failed transplant patients, in whom an early dialysis start is probably mandatory.
Lobbedez
Thierry
T
Service de néphrologie, dialyse et transplantation, CHU Clémenceau, avenue Georges-Clémenceau, 14033 Caen cedex, France. lobbedez-t@chu-caen.fr
Cousin
Maud
M
Hurault de Ligny
Bruno
B
Ficheux
Maxence
M
El Haggan
Wael
W
Ryckelynck
Jean-Philippe
JP
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult