Abstract: TH-PO1020
Effect of Short-Duration Pretransplant Dialysis on Kidney Transplant Outcomes: A Mate-Kidney Analysis
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Daloul, Reem, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- McGill, Rita L., The University of Chicago, Chicago, Illinois, United States
Group or Team Name
- AHN
Background
Pre-emptive kidney transplant provides superior long-term graft and patient outcomes compared to transplant following long-term pre-transplant dialysis. We used a mate-kidney model to clarify the impact of short-duration dialysis exposure on patient and graft survival by matching for donor variables.
Methods
UNOS STAR files were used to identify deceased donors between 2000-2024 from whom one kidney was transplanted into a recipient on maintenance pre-transplant dialysis for ≤ 6 months and the mate-kidney was transplanted pre-emptively. Models were adjusted for recipient (age, gender, race, private insurance, peripheral vasular disease, cancer history, panel reactive antibody titer) and transplantation (transplant center distance, use of left kidney, cold ischemia time, pump perfusion, ABO compatibility, HLA and DR mismatches) variables.
Results
We identified 846 recipients of 423 deceased donors. Median follow up was 48 (IQR=14-108) months. Median dialysis duration in the dialysis group was 3.6 (IQR=1.8-5.1) months. Pre-emptive kidney transplant recipients (KTRs) were older (56±13 vs. 53±14 years, p<0.001), had more private insurance (59% vs. 53%, p=0.048), and less freqently received lymphocyte depleting induction (56% vs. 62%, p=0.03) and mycophenolic acid (80% vs. 85%, p=0.034). Compared to KTRs receiving ≤ 6 months dialysis, pre-emptive KTRs had less graft failure (22.9% vs. 30.7%, p=0.01), and longer median graft survival (48 vs. 40 months, p=0.04). Risk of death and median survival did not differ between paired recipients. Hazard ratios are shown in the table. Pre-emptive transplant status reduced graft failure risk by 47%. Age and private insurance were the only adjustors that affected patient survival.
Conclusion
Our findings in a mate-kidney model suggest that the metabolic, inflammatory and immunologic perturbations associated with pre-transplant dialysis may have adverse impact on graft outcomes even when dialysis exposure is brief.
Adjusted models for transplant outcomes
| Variable | Uncensored graft failure | Death | ||
| Hazard Ratio (95% CI) | P | Hazard Ratio (95% CI) | P | |
| Pre-emptive transplant | 0.53 (0.35, 0.79) | 0.002 | 0.77 (0.48, 1.24) | 0.28 |
| Age, per 10 years | 1.44 (1.09, 1.90) | 0.009 | 2.28 (1.56, 3.33) | <0.001 |
| Private insurance | 0.42 (0.20, 0.86) | 0.018 | 0.45 (0.20, 1.00) | 0.045 |
CI = Confidence interval