title: Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort.
abstract: OBJECTIVE
  Evidence regarding the differences in clinical outcomes after preemptive kidney transplantation (PKT) and non-PKT in Japan is lacking.
  
  
  METHODS
  We conducted a retrospective cohort study at a single center in Japan. Consecutive patients ages >18 years old who had received a kidney transplant from a living donor between November of 2001 and December of 2013 at our institution (n=786) were enrolled. The primary study outcome was the occurrence of clinical events before the end of 2014. Clinical events were defined as any of the following: death with functioning graft (DWFG), graft loss, or post-transplant cardiovascular disease (CVD).
  
  
  RESULTS
  The median follow-up period was 61.0 (35.3-94.0) months. PKT was performed in 239 patients (30.4%). Clinical events occurred in 78 (9.9%). In the Cox proportional hazard model for univariate analysis, factors found to be associated with higher risk of clinical events included older age, men, ABO incompatibility, longer dialysis duration, diabetes, pretransplant CVD, and large ventricular mass index. PKT was associated with lower risk. Clinical event rate in patients who received a PKT was 3.3% compared with 10.8%, 11.1%, 10.4%, 10.2%, 16.7%, and 16.2% among patients who were on dialysis for <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, and ≥5 years before transplant, respectively (P=0.002). The multivariate analysis showed that ABO incompatibility (hazard ratio [HR], 2.98; 95% confidence interval [95% CI], 1.89 to 4.71), duration of dialysis per year (HR, 1.07; 95% CI, 1.03 to 1.11), and diabetes (HR, 3.54; 95% CI, 2.05 to 6.12) were only three independent risk factors for the incidence of clinical events.
  
  
  CONCLUSIONS
  Even in Japan, where the long-term outcomes of patients on hemodialysis are excellent, PKT could be beneficial to reduce DWFG, graft loss, and post-transplant CVD.
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan; ngoto@nagoya2.jrc.or.jp.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Goto
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
authors.forename: Manabu
authors.initials: M
authors.lastname: Okada
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
authors.forename: Makoto
authors.initials: M
authors.lastname: Tsujita
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
authors.forename: Takahisa
authors.initials: T
authors.lastname: Hiramitsu
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
authors.forename: Shunji
authors.initials: S
authors.lastname: Narumi
authors.affiliation: Department of Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan; and.
authors.forename: Akio
authors.initials: A
authors.lastname: Katayama
authors.affiliation: Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan; and.
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016014:Linear Models; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: cohort studies; humans; kidney transplantation; living donor; living donors; proportional hazards models; renal dialysis; risk factors