Comparison of Clinical Outcomes Between Preemptive Transplant and Transplant After a Short Period of Dialysis in Living-Donor Kidney Transplantation: A Propensity-Score-Based Analysis
Hye Yeon Kim, Ji Yoon Choi, Hyun Wook Kwon, Joo Hee Jung, Minkyu Han, Su-Kil Park, Soon Bae Kim, Sang Koo Lee, Young Hoon Kim, Duck Jong Han, Sung Shin
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Ann Transplant 2019; 24:75-83
The permissible extent of pretransplant dialysis for patient and allograft survival is unclear. We assumed that a short period of dialysis before living donor kidney transplantation (LDKT) will show the similar results as preemptive kidney transplantation (PKT).
MATERIAL AND METHODS: We retrospectively evaluated the outcomes of LDKT according to pretransplant dialysis duration in both unmatched cohorts (n=1984) and propensity-score-matched cohorts (n=986) cohorts. The primary study endpoint was post-transplantation patient survival and death-censored graft survival (DCGS) according to the duration of pretransplant dialysis by 19 months which was the best cutoff value to differentiate clinical outcomes with the use of the time-dependent area under the curve.
RESULTS: Of 1984 patients with LDKT at our center between January 2005 and September 2016, PKT was performed in 429 patients. The durations of pretransplant dialysis were <19 months in 962 recipients and ≥19 months in 593 recipients. There was no significant difference in mortality and DCGS between PKT and non-PKT recipients with pretransplant dialysis of <19 months. Patient survival (P=0.024) and DCGS (P=0.001) were worse in non-PKT recipients with pretransplant dialysis of ≥19 months. In the matched cohort, DCGS was significantly lower in non-PKT recipients with pretransplant dialysis of ≥19 months (P=0.037). It is likely that the incidence of biopsy-proven acute rejection was higher in this group (P=0.083).
CONCLUSIONS: Patient survival and DCGS were worse when the pretransplant dialysis duration was ³19 months in a propensity-score-matched LDKT cohort.
Keywords: Dialysis, Kidney Transplantation, propensity score