Survival After Dialysis Initiation: A Comparison of Transplant Patients After Graft Loss Versus Nontransplant Patients

Fresnedo, Gema Fernández; Ruiz, J.C.; Alamillo, Carlos Gómez; Francisco, A.L.M. de; Arias, Manuel

doi:10.1016/j.transproceed.2008.08.094

Cited by 20 publications

(14 citation statements)

References 5 publications

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“…Despite improvements in outcomes, there often remains a mismatch between graft and recipient survival resulting in an eventual requirement for an alternative renal replacement therapy. The survival of individuals with failed transplants on dialysis is poor [4,5,6]. This study demonstrates that incident dialysis patients with a failed renal transplant exhibit a more rapid loss of eGFR in the period prior to dialysis commencement than the transplant-naïve population.…”

Section: Discussionmentioning

confidence: 96%

“…Kidney transplant failure is among the top five causes of end-stage renal disease (ESRD) [3] and it is now common for renal transplant recipients to require a further period of chronic dialysis during their lifetime. The mortality for incident dialysis patients with a failed transplant exceeds that of matched transplant-naïve patients commencing dialysis [4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

“…Renal transplant recipients attend nephrologists frequently and would be expected to have optimal management prior to dialysis commencement. This is not the case [4,9,10]. …”

Section: Introductionmentioning

confidence: 99%

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Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

2014

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Background: It is now common for individuals to require dialysis following the failure of a kidney transplant. Management of complications and preparation for dialysis are suboptimal in this group. To aid planning, it is desirable to estimate the time to dialysis requirement. The rate of decline in the estimated glomerular filtration rate (eGFR) may be used to this end. Methods: This study compared the rate of eGFR decline prior to dialysis commencement between individuals with failing transplants and transplant-naïve patients. The rate of eGFR decline was also compared between transplant recipients with and without graft failure. eGFR was calculated using the four-variable MDRD equation with rate of decline calculated by least squares linear regression. Results: The annual rate of eGFR decline in incident dialysis patients with graft failure exceeded that of the transplant-naïve incident dialysis patients. In the transplant cohort, the mean annual rate of eGFR decline prior to graft failure was 7.3 ml/min/1.73 m² compared to 4.8 ml/min/1.73 m² in the transplant-naïve group (p < 0.001) and 0.35 ml/min/1.73 m² in recipients without graft failure (p < 0.001). Factors associated with eGFR decline were recipient age, decade of transplantation, HLA mismatch and histological evidence of chronic immunological injury. Conclusions: Individuals with graft failure have a rapid decline in eGFR prior to dialysis commencement. To improve outcomes, dialysis planning and management of chronic kidney disease complications should be initiated earlier than in the transplant-naïve population.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

2014

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“…The available evidence suggests that this is not the case. Markers of anaemia, nutrition, inflammation, and mineral bone disease are reportedly worse in the failed renal transplant population than in transplant-naïve patients at the initiation of dialysis [7,12-14]. This is despite the fact that one quarter of the incident dialysis population are not known to a nephrologist more than 1 month prior to commencing dialysis therapy [15].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing survival after kidney transplant failure

et al. 2014

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BackgroundThe failure of a kidney transplant is now a common reason for initiation of dialysis therapy. Kidney transplant recipients commencing dialysis have greater morbidity and mortality than transplant-naïve, incident dialysis patients. This study aimed to identify variables associated with survival after graft failure.MethodsAll recipients of first, deceased donor kidney transplants performed in Northern Ireland between 1986 and 2005 who had a functioning graft at 12 months were included (n = 585). Clinical and blood-derived variables (age, gender, primary renal disease, diabetic status, smoking status, human leukocyte antigen (HLA) mismatch, acute rejection episodes, immunosuppression, cardiovascular disease, graft survival, haemoglobin, albumin, phosphate, C reactive protein, estimated glomerular filtration rate (eGFR), rate of eGFR decline, dialysis modality, and access) were collected prospectively and investigated for association with re-transplantation and survival. The association between re-transplantation and survival was explored by modelling re-transplantation as a time-dependent covariate.ResultsMedian follow-up time was 12.1 years. Recipients with a failing graft (158/585) demonstrated rapid loss of eGFR prior to graft failure, reducing the time available to plan for alternative renal replacement therapy. Median survival after graft failure was 3.0 years. In multivariate analysis, age and re-transplantation were associated with survival after graft failure. Re-transplantation was associated with an 88% reduction in mortality.ConclusionsOptimal management of kidney transplant recipients with failing grafts requires early recognition of declining function and proactive preparation for re-transplantation given the substantial survival benefit this confers. The survival benefit associated with re-transplantation persists after prolonged exposure to immunosuppressive therapy.

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“…However, it is their survival compared to transplant naïve dialysis patients, which has been the source of serious controversy [7] [8]. Few observational studies have reported worse survival among FTRD patients [9] [10] but most were smallsized studies with methodological problems. On the other hand, similar mortality as in transplant-naïve patients has been observed by Akbari [11] and also reported by the Canadian Organ Replacement Register (CORR) [7].…”

Section: Introductionmentioning

confidence: 99%

Patients Returning to Dialysis after Failed Kidney Transplant: How Do They Fare? A Gulf Perspective

Abouchacra¹,

Chaaban²,

Saleh³

et al. 2014

OJIM

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An increasing number of failed transplant patients returning to dialysis (FTRD) have been observed with reported worse survival compared to transplant-naive dialysis (TxN) patients. This study aimed to assess outcomes of FTRD vs. matched TxN controls in a Gulf region multi-center trial of 800 HD patients. Similar mortality was seen, likely due to earlier start and better HD adequacy in FTRD. Younger age, less diabetes and living donor transplantation in majority with 27% graft nephrectomy (Nx) might also confer benefits. Subgroup analysis of Nx patients showed more hospitalizations and prior rejection episodes with lower graft survival. The deaths, however, occurred only in nonNx group and are likely explained by older age, longer duration on HD, more prevalence of diabetes and CAD. FTRD showed similar survival to TxN. Early intensive HD might account for the benefit. Whether Nx confers advantage is unclear because of the small sample size.

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Survival After Dialysis Initiation: A Comparison of Transplant Patients After Graft Loss Versus Nontransplant Patients

Cited by 20 publications

References 5 publications

Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

Factors influencing survival after kidney transplant failure

Patients Returning to Dialysis after Failed Kidney Transplant: How Do They Fare? A Gulf Perspective

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