Abstract: FR-PO1196
Pre-Transplant Dialysis Modality and Long-Term Patient and Kidney Allograft Outcome: A 15-Year Retrospective Cohort Study
Session Information
- Transplantation: Clinical - Immunosuppression, Adherence, Outcomes
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Balzer, Michael S., Hannover Medical School, Hannover, Germany
- Pankow, Stephanie, Hannover Medical School, Hannover, Germany
- Claus, Robert, Hannover Medical School, Hannover, Germany
- Ruben, Stephan, Hannover Medical School, Hannover, Germany
- Haller, Hermann G., Hannover Medical School, Hannover, Germany
- Einecke, Gunilla, Hannover Medical School, Hannover, Germany
Background
Among factors determining long-term kidney allograft outcome, pre-transplant renal replacement therapy (RRT) is the most easily modifiable. Previous studies analyzing the impact of RRT modality on patient and graft survival are conflicting. Studies on allograft function are scarce and lack sufficient size, follow-up time or generalizability.
Methods
We retrospectively studied patient and allograft survival as well as allograft function and its decline in 2277 allograft recipients who received a kidney transplant at our tertiary care center during 2000-2014. Pre-transplant RRT modality ≥60 days as grouped into ‘no RRT’ (n=136), ‘hemodialysis (HD)’ (n=1847), peritoneal dialysis (PD)’ (n=159), and ‘HD+PD’ (n=135) was evaluated.
Results
Unadjusted (Kaplan-Meier) primary outcomes demonstrated superior 5-, 10-, and 15-yr patient and death-censored graft survival in PD vs. HD patients (p<0.001 and p=0.016, respectively). Adjusted Cox regression revealed 35.6% lower hazards of death (p=0.038), whereas hazards for death-censored graft loss were similar (p=0.204). Secondary outcomes of allograft function showed significantly lower 1-, 3-, and 5-yr serum creatinine in ‘PD’ vs. ‘HD’ groups (p=0.007, p=0.048, and p=0.012, respectively). Living donation benefit for allograft function was most pronounced in groups ‘no RRT’ and ‘PD’. Although not statistically significant, functional allograft decline measured by estimated glomerular filtration rate (eGFR) slope was lowest in PD patients. Recipients on pre-transplant PD with living donation grafts even demonstrated eGFR gain during post-transplant years 1-5.
Conclusion
Allograft recipients on pre-transplant PD vs. HD demonstrated superior all-cause and similar graft survival. Allograft function was better in PD vs. HD patients, although the trajectory of functional decline was similar.
Funding
- Private Foundation Support