Pretransplant hemodialysis for more than 10 years found to predict worse graft and patient survival

Patients on hemodialysis (HD) for more than 10 years prior to renal transplantation have worse outcomes after receiving their kidneys compared with patients who received HD for shorter periods, according to Japanese researchers.

A team at Kyoto Prefectural University Graduate School of Medical Science led by Hidetaka Ushigome, MD, PhD, studied 436 patients who underwent renal transplantation. Of these, 39 had been treated with pretransplant HD for more than 10 years (mean 15.8 years; long-term group) and 397 had received HD for less than 10 years (mean 3.7 years; short-term group). The long- and short-term groups had a mean age of 55.3 and 39 years, respectively.

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Graft survival rates in the long-term and short-term groups were 89.2% and 95.8%, respectively, at one year, 60.4% and 88.5% at five years, and 33.4% and 80.4% at 10 years, the authors reported in Transplantation Proceedings (2008;40:2297-2298). Patient survival rates were 93.2% and 98.6%, 79.3% and 95.4%, and 58.4% and 93.1%, respectively.

Additionally, eight patients in the long-term group (20.5%) experienced acute rejection compared with 63 in the short-term group (15.7%).

Pretransplant complications, including diabetes mellitus, CVD, hypertension, and hepatitis C virus and cytomegalovirus infection, occurred more frequently in the long-term than in the short-term group.

The researchers believe impaired intestinal absorption reduced uptake of immunosuppressive agents, which led to deficits in immunosuppression and subsequent acute rejection episodes.