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Kidney Week

Abstract: PO2518

Trends in Time to Graft Loss by Dialysis Exposure

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Ahearn, Patrick, Stanford University School of Medicine, Stanford, California, United States
  • Lenihan, Colin R., Stanford University School of Medicine, Stanford, California, United States
  • Scandling, John D., Stanford University School of Medicine, Stanford, California, United States

Preemptive transplantation is believed superior to transplantation after dialysis initiation, and transplantation after shorter dialysis exposure is better than with longer exposure. Considering recent registry reports of improved survival on dialysis, we examined temporal trends of graft loss by time on dialysis prior to kidney transplantation.


Using the US Renal Data System, we identified adults who underwent first kidney transplant between January 1, 1995 and July 31, 2017. We excluded recipients of simultaneous multiorgan transplants. We used an adjusted Cox model to examine the association between dialysis exposure prior to transplantation (categorized as preemptive, <6 months, 6 months-1 year, 1-3 years, 3-5 years, and >5 years) and graft failure within 3 years of transplant. Our model was adjusted for donor and recipient demographic factors, donor type, cause of ESKD, BMI, panel reactive antibodies, diabetes status, and cardiovascular disease status. We organized patients into the following transplant era groupings: 1995-2001, 2002-2006, 2007-2011, and 2012-2017.


A total of 277,158 transplant recipients were studied and 38,364 had graft loss within 3 years. In each era, the hazard ratio for graft loss was lower for preemptive transplant recipients (referent group) compared to all other dialysis exposures except for the group that received less than 6 months of dialysis in the 2012-2017 era (HR 1.06 (95% CI 0.91-1.24)). Those exposed to more than 5 years of dialysis exposure had the highest risk for graft loss within 3 years in all eras, with over 2 times the hazard compared to the referent group in the most recent eras (figure).


Although preemptive transplantation offers the best graft survival across the study period, those transplanted within 6 months of dialysis initiation had similar 3-year graft survival to those transplanted preemptively in the most recent era. The negative association between the longest duration of pre-transplant dialysis and post-transplant survival persists.


  • NIDDK Support