title: The role of pretransplant dialysis modality on renal allograft outcome.
abstract: OBJECTIVE
  The pretransplant dialysis modality might influence renal allograft and patient survival after transplantation. Studies published to date yielded conflicting results.
  
  
  METHODS
  Deceased-donor allograft recipients reported to the 'Collaborative Transplant Study' were analysed, using multivariate Cox regression analysis, considering potential confounders which included pretransplant patient cardiovascular risk evaluation as well as immunological and treatment parameters. Primary end points were all-cause graft survival, death-censored graft survival and patient survival.
  
  
  RESULTS
  In total, 60,008 recipients were analysed. Patients who were on peritoneal dialysis (PD) (n = 11,664) prior to transplantation demonstrated a 10% lower all-cause mortality (P = 0.014) but similar death-censored graft survival (P = 0.39) as recipients treated with haemodialysis (n = 45,651). This lower all-cause mortality in PD patients was primarily a consequence of a significantly lower rate of cardiovascular death with a functioning graft (P < 0.013) in a subcohort of patients defined as at increased risk.
  
  
  CONCLUSIONS
  Pretransplant dialysis modality per se has no significant impact on allograft outcome. Superior all-cause survival of PD patients is primarily due to a lower rate of cardiovascular death in a subcohort of high-risk recipients. This might explain the conflicting results published to date.
authors.affiliation: Department of Nephrology, University of Heidelberg, Heidelberg, Germany. vedat.schwenger@med.uni-heidelberg.de
authors.forename: Vedat
authors.initials: V
authors.lastname: Schwenger
authors.forename: Bernd
authors.initials: B
authors.lastname: Döhler
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000401:mortality* / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate