Influence of dialysis duration and modality on kidney transplant outcomes.
BACKGROUND
The influence of pretransplantation dialysis on kidney transplant outcomes has been the subject of longstanding interest. Although increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survivals, analyses of the impact of dialysis modality on kidney allograft outcome have produced conflicting results.


OBJECTIVE
The objective of this study was to evaluate the influence of dialysis duration and modality on the function and survival of renal allografts.


METHODS
We retrospectively reviewed the clinical data of 421 adults who received first kidney transplantations from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007. Three hundred seventy-four patients (88.8%) were on hemodialysis (HD) prior to kidney transplantation, including 247 patients (58.7%) on treatment for at least 24 months.


RESULTS
Patients with a dialysis duration > or =24 months were significantly older (45.9 vs 42.8 years; P = .013). Renal function at 3, 12, 60, and 96 months was similar between the 2 groups. Longer duration on dialysis was associated with poorer overall graft and patient survivals. No differences were observed in renal function or graft and patient survivals comparing HD or peritoneal dialysis (PD). Multivariate analysis confirmed the lack of correlation between dialysis duration or modality and allograft failure.


CONCLUSIONS
Longer dialysis duration influenced overall graft and patient survival. However, dialysis modality showed no influence on graft function or survival.
Department of Nephrology, Hospital Central do Funchal, Funchal, Portugal. lmmresende@hotmail.com
L
L
Resende
J
J
Guerra
A
A
Santana
C
C
Mil-Homens
F
F
Abreu
A G
AG
da Costa
D000328:Adult; D000367:Age Factors; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies; D012727:Sex Characteristics; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D055815:Young Adult