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- Title
The impact of pre-transplant dialysis on simultaneous pancreas–kidney versus living donor kidney transplant outcomes.
- Authors
Wiseman, Alexander C.; Huang, Edmund; Kamgar, Mandana; Bunnapradist, Suphamai
- Abstract
Background Pre-transplant dialysis is known to affect kidney graft survival. Here, we report the impact of pre-transplant dialysis on patient and graft survival of type 1 diabetic recipients of either a simultaneous pancreas–kidney (SPK) or living donor kidney (LDK) transplant. Methods Using the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database, 6822 adult type 1 diabetic recipients transplanted through 2000–2011 were identified. Patients were categorized based on pre-transplant dialysis time (DT): preemptive recipients (P-LDK, n = 498; P-SPK, n = 1529), recipients with <1 year of DT (0–1 year DT; LDK n = 582, SPK n = 1700), and those with 1–2 years DT (1–2 year DT; LDK n = 301, SPK n = 2212). Seven-year patient and kidney survival were examined. Results Compared with the P-SPK group, both 0–1 year DT and 1–2 year DT SPK recipients had lower 7-year patient survival (89, 84 & 84% respectively; log-rank P-value versus P-SPK = 0.01 & <0.001). For LDK groups, DT > 1 year was associated with inferior patient survival (7-year survival 76% versus 87% for P-LDK, P-value versus P-LDK = 0.009). Comparing P-LDK to all other SPK groups, there was no significant difference in 7-year patient or kidney survival. Conclusions Preemptive transplantation is associated with the highest patient survival in both LDK and SPK. Compared with the P-LDK group, DT > 1 year is associated with lower patient survival among LDK recipients, but there is no difference in survival with dialysis up to 2 years with SPK. These results highlight the differential impact of DT on LDK and SPK transplantation.
- Subjects
HEMODIALYSIS; KIDNEY transplantation; PANCREAS transplantation; PROCUREMENT of organs, tissues, etc.; KIDNEY exchange; ORGAN donation
- Publication
Nephrology Dialysis Transplantation, 2013, Vol 28, Issue 4, p1047
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfs582