title: [Dialysis after graft failure: How to improve survival?].
abstract: Ten to 15 % of transplant recipients will return to dialysis, or require another transplantation within 5years, rising to 23 % by 10years, and failed transplantation is now one of the major indications for starting dialysis, accounting for almost 5 % of incident dialysis patients in the US and 10 % in France. Patients who resume dialysis post-transplantation have usually experienced an extended period of uraemia and long-term immunosuppressive therapy, and exhibit high rates of anaemia and erythropoietin resistance, hypoalbuminaemia and persistent chronic inflammation from the failed graft. These factors may increase mortality risk during the first year of dialysis, as observed in the US, but not in Canada or France. When compared to a control group of transplant-naive patients followed in the same institution in France, patients with transplant failure have a higher rate of usable arteriovenous fistula or graft, a similar rate of non-planned dialysis, and initiate dialysis with a higher glomerular filtration rate. We suggest that patient survival in dialysis after graft loss is influenced by both patient characteristics and quality of care, and this may explain the favourable outcome of this specific dialysis population in France.
authors.affiliation: Département de néphrologie, dialyse et transplantation, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: g-mourad@chu-montpellier.fr.
authors.forename: Georges
authors.initials: G
authors.lastname: Mourad
authors.affiliation: Département de néphrologie, dialyse et transplantation, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: Ilan
authors.initials: I
authors.lastname: Szwarc
authors.affiliation: Département de néphrologie, dialyse et transplantation, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: Aurèle
authors.initials: A
authors.lastname: Buzançais
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Dialyse; Dialysis; Kidney graft failure; Patient survival; Quality of care; Qualité des soins; Survie patient; Échec de transplantation