The Effect of Pretransplantation Dialysis Modality on Long-term Recipient and Graft Survival in Living Donor Kidney Transplantation

Shin, Sung Joon; Joo, Kwon Wook; Ahn, Curie; Kim, Suhng Gwon; Lee, Jung Sang; Ha, Jong Won; Kim, Sang Jun; Kim, Yon Su

Abstract

PURPOSE: There is increasing consideration about the preemptive transplantation, transplantation without any preceding dialysis, as a one of options of a renal replacement therapy (RRT). This study evaluates a beneficial effect on recipient and allograft survival of preemptive transplantation and compares the outcome to that according to the dialysis modality and duration.
METHODS
All patient who had received a kidney transplant from a living donor in the Seoul National University Hospital (SNUH) between January 1990 and October 2004 are included in this retrospective study. Patients were subdivided into three groups; preemptive transplant group (group 1, n=47), hemodialysis group (group 2, n=307) and peritoneal dialysis group (group 3, n=52).
RESULTS
The characteristics of each groups were not statistically different except recipient age. Ten-year patient survival was 97.8% in PE group, but is not significantly higher than in HD (89.4%) and in PD (90.7%) groups. However, 10-year graft survival was higher in PE group than in HD group (p<0.05; 100%, 74.7% respectively). The differential effect of pretransplant dialysis duration on graft survival was prominent if the patients had been on the pretransplant dialysis for more than 42 months (p<0.05; 10-year graft survival; PE, 100% and dialysis more than 42 months, 77.9% respectively) Compared with HD group as a pre-transplant dialysis modality, PD group showed better patient and graft survival rate, but not statistically significant.
CONCLUSION
Depending on the above results, we may suggest PE or PD being a superior pre-transplant modality than HD. And we should be considerate of choosing treatment modality and duration before transplantation.