Preemptive kidney transplantation: a propensity score matched cohort study

Okumi, Masayoshi; Sato, Yasuyuki; Unagami, Kohei; Hirai, Toshihito; Ishida, Hideyuki; Tanabe, Kazunari

doi:10.1007/s10157-016-1345-x

Cited by 8 publications

(4 citation statements)

References 42 publications

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“…The JACK is an ongoing multicentre, observational cohort study conducted in Japan. The objectives and protocol of the JACK have been described in more detail previously 8 16 17. The participants were patients who underwent KT at Tokyo Women’s Medical University and visited the outpatient Yochomachi Clinic for follow-up assessments.…”

Section: Methodsmentioning

confidence: 99%

Predictors of return to work after kidney transplantation: a 12-month cohort of the Japan Academic Consortium of Kidney Transplantation study

et al. 2019

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ObjectivesTo investigate the cumulative return-to-work (RTW) rate and to identify predictors of employment after kidney transplantation (KT).DesignRetrospective, outpatient-based cohort study.SettingThis was a single-centre study of the largest Japanese kidney transplant centre.ParticipantsWe selected Japanese kidney transplant recipients aged 20–64 years who were employed in paid jobs at the time of transplantation and who visited an outpatient clinic from December 2017 to March 2018. From 797 patients, we evaluated 515 in this study.InterventionsWe interviewed patients at an outpatient clinic and investigated the timing and predictors of RTW using logistic regression models.Primary and secondary outcome measuresThe primary outcome was the cumulative RTW rate, and the secondary outcome was to investigate the predictors of RTW after KT.ResultsAmong the 515 included recipients, the cumulative overall partial/full RTW rates at 2, 4, 6 and 12 months were 22.3%, 59.0%, 77.1% and 85.0%, respectively. The median duration from transplantation to RTW was 4 months. Regarding partial/full RTW, according to the multivariable analysis including all variables, male sex was a greater predictor for RTW than female sex (OR 2.05, 95% CI 1.32 to 3.20), and a managerial position was a greater predictor than a non-managerial position (OR 2.23, 95% CI 1.42 to 3.52). Regarding full RTW, male sex (OR 1.95, 95% CI 1.25 to 3.06) and managerial position (OR 1.95, 95% CI 1.25 to 3.06) were also good predictors.ConclusionsThe cumulative RTW rate was 85.0% 1-year post-transplantation. Given that cumulative RTW rates varied by sex and position, transplant and occupational physicians should support kidney transplant recipients in the aspect of returning to work.Trial registration numberUMIN000033449

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Section: Methodsmentioning

confidence: 99%

Predictors of return to work after kidney transplantation: a 12-month cohort of the Japan Academic Consortium of Kidney Transplantation study

et al. 2019

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“…Therefore, a physician has to be able to recommend an optimal time of transplantation when a patient with end-stage renal disease considers LDKT in order to minimize the length of dialysis duration for favorable long-term outcomes. Although Okumi et al [2] compared the clinical outcomes of PKT with those of non-PKT in a propensity-score-matched cohort, they only revealed that PKT was not associated with either improvement of post-transplant renal function or with a lower rate of common post-transplant complications compared with non-PTK. In the propensity-score-matched cohort of this study, however, it was evident that recipients with a short pretransplant dialysis duration had similar long-term outcomes to those who had PKT, whereas they had superior results to those with a long pretransplant dialysis duration in terms of mortality, graft survival, and BPAR.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes Between Preemptive Transplant and Transplant After a Short Period of Dialysis in Living-Donor Kidney Transplantation: A Propensity-Score-Based Analysis

et al. 2019

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BackgroundThe permissible extent of pretransplant dialysis for patient and allograft survival is unclear. We assumed that a short period of dialysis before living donor kidney transplantation (LDKT) will show the similar results as preemptive kidney transplantation (PKT).Material/MethodsWe retrospectively evaluated the outcomes of LDKT according to pretransplant dialysis duration in both unmatched cohorts (n=1984) and propensity-score-matched cohorts (n=986) cohorts. The primary study endpoint was post-transplantation patient survival and death-censored graft survival (DCGS) according to the duration of pretransplant dialysis by 19 months which was the best cutoff value to differentiate clinical outcomes with the use of the time-dependent area under the curve.ResultsOf 1984 patients with LDKT at our center between January 2005 and September 2016, PKT was performed in 429 patients. The durations of pretransplant dialysis were <19 months in 962 recipients and ≥19 months in 593 recipients. There was no significant difference in mortality and DCGS between PKT and non-PKT recipients with pretransplant dialysis of <19 months. Patient survival (P=0.024) and DCGS (P=0.001) were worse in non-PKT recipients with pretransplant dialysis of ≥19 months. In the matched cohort, DCGS was significantly lower in non-PKT recipients with pretransplant dialysis of ≥19 months (P=0.037). It is likely that the incidence of biopsy-proven acute rejection was higher in this group (P=0.083).ConclusionsPatient survival and DCGS were worse when the pretransplant dialysis duration was ≥19 months in a propensity-score-matched LDKT cohort.

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“…KT candidates are considered to have a high prevalence of periodontal disease due to the status of end-stage of renal insufficiency, which is called stage-five CKD. There has been a recent increase in the number of preemptive kidney transplantation (PEKT) procedures, which are defined as transplant before initiation of maintenance dialysis therapy, for the avoidance of complication by dialysis therapy [80]. PEKT is often performed at the progression of renal deterioration in the pre-dialysis stage.…”

Section: Periodontal Disease and Kidney Transplantationmentioning

confidence: 99%

Pathological Characteristics of Periodontal Disease in Patients with Chronic Kidney Disease and Kidney Transplantation

Kitamura

Mochizuki

Miyata

et al. 2019

IJMS

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Chronic kidney disease (CKD) is recognized as an irreversible reduction of functional nephrons and leads to an increased risk of various pathological conditions, including cardiovascular disease and neurological disorders, such as coronary artery calcification, hypertension, and stroke. In addition, CKD patients have impaired immunity against bacteria and viruses. Conversely, kidney transplantation (KT) is performed for patients with end-stage renal disease as a renal replacement therapy. Although kidney function is almost normalized by KT, immunosuppressive therapy is essential to maintain kidney allograft function and to prevent rejection. However, these patients are more susceptible to infection due to the immunosuppressive therapy required to maintain kidney allograft function. Thus, both CKD and KT present disadvantages in terms of suppression of immune function. Periodontal disease is defined as a chronic infection and inflammation of oral and periodontal tissues. Periodontal disease is characterized by the destruction of connective tissues of the periodontium and alveolar bone, which may lead to not only local symptoms but also systemic diseases, such as cardiovascular diseases, diabetes, liver disease, chronic obstructive pulmonary disease, and several types of cancer. In addition, the prevalence and severity of periodontal disease are significantly associated with mortality. Many researchers pay special attention to the pathological roles and clinical impact of periodontal disease in patients with CKD or KT. In this review, we provide information regarding important modulators of periodontal disease to better understand the relationship between periodontal disease and CKD and/or KT. Furthermore; we evaluate the impact of periodontal disease on various pathological conditions in patients with CKD and KT. Moreover, pathogens of periodontal disease common to CKD and KT are also discussed. Finally, we examine the importance of periodontal care in these patients. Thus, this review provides a comprehensive overview of the pathological roles and clinical significance of periodontal disease in patients with CKD and KT.

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Preemptive kidney transplantation: a propensity score matched cohort study

Abstract: PKT was associated with neither improvement of post-transplant renal function nor a lower rate of common post-transplant complications than non-PKT among patients with end-stage renal disease who underwent living KT.

Cited by 8 publications

References 42 publications

Predictors of return to work after kidney transplantation: a 12-month cohort of the Japan Academic Consortium of Kidney Transplantation study

Predictors of return to work after kidney transplantation: a 12-month cohort of the Japan Academic Consortium of Kidney Transplantation study

Comparison of Clinical Outcomes Between Preemptive Transplant and Transplant After a Short Period of Dialysis in Living-Donor Kidney Transplantation: A Propensity-Score-Based Analysis

Pathological Characteristics of Periodontal Disease in Patients with Chronic Kidney Disease and Kidney Transplantation

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