Comparison of clinical outcomes between preemptive and transplant after a short period of dialysis in living donor kidney transplantation : A propensity score-based analysis.

Abstract

It is unclear what extent of pre-transplant dialysisis permissible in terms of patient and allograft survival. We retrospectively evaluated outcomes of living donor kidney transplantation(LDKT) according to the duration of pre-transplant dialysis in both unmatched (n=1,984) and propensity score matched cohorts (n=986). The most appropriate cut-off value of pre-transplant dialysis duration to differentiate clinical outcomes was 19 months. Of 1,984 patients who had LDKT at our center between January 2005 and September 2016, preemptive kidney transplantation (PKT) was performed in 429 patients. The duration of pre-transplant dialysis was less than 19 months in 962 recipients while the duration was equal to and longer than 19 months in 593 recipients. There was no significant difference in mortality and death-censored graft survival (DCGS) between PKT and non-PKT recipients with pre-transplant dialysis less than 19 months. Meanwhile, patient survival (p=0.024) and DCGS (p=0.001) turned out to be worse in non-PKT recipients with pre-transplant dialysis equal to and longer than 19 months. In the matched cohort, DCGS was significantly lower in non-PKT recipients with pre-transplant dialysis equal to and longer than 19 months (p=0.037). Furthermore, it is likely that the incidence of biopsy-proven acute rejection was higher in this group (p=0.083). In conclusion, patient survival and DCGS were worse when pre-transplant dialysis duration was equal to and longer than 19 months in a propensity score matched LDKT cohort.