Patients with a dialysis vintage of 15 years or more have worse graft and overall survival after kidney transplantation than patients with a shorter vintage, investigators reported at the 60th European Renal Association Congress in Milan, Italy.
Gizem Kumru, MD, and colleagues from Ankara University in Ankara, Turkey, compared 29 patients with a median dialysis vintage of 226 months and 394 patients with a median dialysis vintage of 25 months from a single center. In the long dialysis vintage group, 96.6% were on hemodialysis and 82.8% received a deceased donor transplant. In the short dialysis vintage group, 32.5% had preemptive surgery and 85.8% received a living donor transplant.
Graft loss occurred in 17.2% of the long-vintage group at a mean 16 months and 7.4% of the short-vintage group at a mean 45 months, the investigators reported. Graft survival rates at 1, 3, and 5 years were 88.9%, 84.6%, and 54.5% in the long-vintage group and 98.1%, 94.1%, and 84.3% in the short-vintage group, respectively. Episodes of acute rejection in the first year or later occurred at comparable rates between groups. Anti-human T-thymocyte globulin was the predominant induction therapy for the long vintage group, but maintenance therapies were similar.
A significantly greater proportion of the long-vintage group died: 17.2% vs 6.3%.
Dr Kumru’s team pointed out that the long-vintage group was significantly older (mean age 50 vs 44 years), had higher rates of pre-existing hepatitis C (28.6% vs 2%), and had lower rates of panel reactive antibody (59.3% vs 75.7%).
The wait time to kidney transplantation is much longer for highly sensitized vs unsensitized patients: 2232 vs 788 days, Dr Kumru’s team noted.
“Strategies to avoid sensitization and reduce waiting times on dialysis should be established.”
Kumru G, Eyupoglu S, Şengül S, Keven K. Effect of extremely long dialysis vintage on renal allograft survival: a single-center experience. Presented at: ERA 2023 Congress; 2023 June 15-18; Milan, Italy. Poster 7669.