Effects of pre-transplant dialysis modality on early outcome of kidney transplantation from donation after cardiac death

This retrospective study was designed to compare the cause of hospitalization and influencing factors between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Baseline data and laboratory parameters of 192 dialysis patients (92 HD patients and 100 PD patients) were compared. Quantitative parameters with normal distribution were assessed using independent t-test or analysis of variance (ANOVA). Quantitative parameters with non-normal distribution were assessed by non-parametric test. Qualitative data were statistically compared using χ2 test. The number of patients with urban employee medical insurance (88 HD patients and 60 PD patients) and rural cooperative medical care (12 HD patients and 40 PD patients) significantly differed (P < .01). The hospitalization rate of PD patients was significantly higher than that of HD counterparts. The average length of hospital stay of PD patients was 10 days, remarkably longer than 8 days of HD patients (P < .01). The primary cause of hospitalization for HD patients was infection-related complications, followed by cardiovascular, cerebrovascular complications and dialysis access disorders. The primary cause of hospitalization for PD patients was infection-related complications, followed by dialysis access disorders, cardiovascular, and gastrointestinal complications. Compared with the HD group, the levels of hemoglobin, serum albumin, alkaline phosphatase, intact parathyroid hormone were significantly decreased, whereas serum urea nitrogen, serum creatinine, phosphorus levels and cardiothoracic ratio were remarkably increased in the PD group (all P < .01). The hospitalization rate of PD patients is relatively higher, and the length of hospital stay is longer. Extensive attention and efforts should be delivered to enhance the understanding of disease and lower the risk of complications for patients.

Background and Aims Among peritoneal dialysis (PD) or hemodialysis (HD) while waiting for a kidney transplant (KT), which is better in terms of KT outcomes has long been of interest. Nowadays it is difficult to agree on which modality is better. The primary objective of this study was to compare the incidence of composite outcomes (delayed graft function, primary non-function, biopsy-proven acute rejection) within 1 year after primary adult KT between recipients taken PD and HD before KT (PD group vs. HD group, respectively). Method This study was a prospective, multi-sites cohort study. We used a propensity score matching to control for patients characteristics. Results Total 1040 patients were enrolled consecutively. Among them, 1030 patients (248, PD group; 782, HD group) were included in the final analysis. The HD group was older and had higher prevalence of diabetes, higher Charlson comorbidity index score, higher prevalence of positive PRA and more prescription of rituximab than the PD group significantly. After propensity score matching (246, PD group; 476, HD group), there were no differences in baseline characteristics between the two groups. In the whole population, there was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.88 ∼ 1.77, p = 0.21). There were also no differences in the risk of each component in the composite outcomes between the two groups. Primary non-function, a component of the composite outcomes did not occur in the both groups. There were no differences in the risks of death, frequency and total duration of re-hospitalization after KT for 1 year, and the changes of eGFR for 1 year between the two groups. The results from the propensity score matched population were consistent with those from the whole population. There was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, HR 1.17, 95% CI 0.80 ∼ 1.74, p = 0.43). Conclusion The pre-transplant dialysis modality does not affect the incidences of delayed graft function and acute rejection in early period of KT. (NCT01513707) This study was supported by Baxter Incorporated.

Objective To explore the incidence and risk factors of infection after donation after cardiac death (DCD) kidney transplantation.Method The clinical data of 265 recipients and donors of DCD kidney transplantation performed in our hospital from February 2007 to December 2013 were retrospectively.The infection incidence after DCD kidney transplantation,and the time,positions,and pathogens of infection were observed.The potential risk factors for postoperative infection,such as donor infection,acute rejection,delayed graft function (DGF),diabetes and immunosuppressive regimens were recorded.Result The total postoperative infection incidence was 31.3％.49.4％ infections occurred within the 1 month postoperatively.Incidence of infection by virus,bacteria,and fungi was 37.3％,42.2％ and 4.8％ respectively.The mixed infection incidence was 15.7％.The most common positions for infection were upper respiratory tract,lung and urinary tract.Univariate analysis showed that risk factors for infection after DCD kidney transplantation included acute rejection,DGF,WBC ＜4 × 109/L,donor infection and diabetes (P＜0.05).Logistic multivariate regression showed that acute rejection,DGF and WBC ＜4 × 109/L were independent risk factors for infection after DCD kidney transplantation (OR =8.857,2.201 and 2.494,respectively,P＜0.05).Conclusion Infection is common complication after DCD kidney transplantation.Treating risk factors for infection such as acute rejection,DGF and leucopenia may reduce the infection incidence after DCD kidney transplantation. Key words: Donation after cardiac death; Kidney transplantation; Infection; Risk factor

The present study investigated the influence of the pretransplant dialysis modality, hemodialysis (HD) or peritoneal dialysis (PD), on renal transplant complications and outcomes. 402 cadaveric renal transplant patients maintained on HD (N = 303) or PD (N = 99) for more than 3 months prior to transplantation were studied retrospectively, and a total of 345 patients were followed up for 30.2 +/- 15.2 months. The impact of HD or PD on acute rejection, delayed graft function (DGF), infection, chronic rejection, and the survival rate of graft and patients were analyzed. There was no significant difference between the HD and PD groups with regard to the causes of end-stage renal disease, age, gender, blood pressure, hemoglobin, HLA match, hot and cold ischemia time, and hepatitis C virus infection. The incidence rates of DGF, acute rejection, chronic rejection and cytomegalovirus and other infections were also not significantly different between the HD and PD groups. However, compared to HD, patients with PD had longer dialysis duration (p < 0.05), but less hepatitis B infection (p < 0.05) and post-transplant infection (p < 0.05). In contrast, in those PD patients with hepatitis B infection, graft loss was significantly increased (19.23% vs. 8.86% , p = 0.021). The incidence of acute rejection episodes was higher in HD patients who had pretransplant dialysis for more than 12 months (p < 0.05). The overall patient and graft survival rates within 5 years between the HD and PD groups were not significantly different (p > 0.05). The influence of PD and HD on complications after renal transplant at 1 year and 5 years and graft survival rates was similar, and therefore, either HD or PD can be chosen as the pretransplant dialysis modality. However, patients in the PD group had a reduced incidence of hepatitis virus infection, suggesting that PD may have certain advantages over HD as a preoperative substitution therapy for renal transplantation.

Background/AimsMany studies have compared patients with systemic lupus erythematosus (SLE) on renal replacement therapy (RRT) with non-lupus patients. However, few data are available on the long-term outcome of patients with end-stage renal disease (ESRD) secondary to SLE who are managed by different types of RRTs.MethodsWe conducted a retrospective multicenter study on 59 patients with ESRD who underwent maintenance RRT between 1990 and 2007 for SLE. Of these patients, 28 underwent hemodialysis (HD), 14 underwent peritoneal dialysis (PD), and 17 patients received kidney transplantation (KT). We analyzed the clinical outcomes in these patients to determine the best treatment modality.ResultsThe mean follow-up period was 5 ± 3 years in the HD group, 5 ± 3 years in the PD group, and 10 ± 5 years in the KT group (p = 0.005). Disease flare-up was more common in the HD group than in the KT group (p = 0.012). Infection was more common in the PD and HD groups than in the KT group (HD vs. KT, p = 0.027; PD vs. KT, p = 0.033). Cardiovascular complications were more common in the HD group than in the other groups (p = 0.049). Orthopedic complications were more common in the PD group than in the other groups (p = 0.028). Bleeding was more common in the HD group than in the other groups (p = 0.026). Patient survival was greater in the KT group than in the HD group (p = 0.029). Technique survival was lower in the PD group than in the HD group (p = 0.019).ConclusionsAmong patients with ESRD secondary to SLE, KT had better patient survival and lower complication rates than HD and lower complication rates than PD. The prognosis between the HD and PD groups was similar. We conclude that if KT is not a viable treatment option, any alternative treatment should take into account the patient's general condition and preference.

Delayed graft function (DGF) and acute rejection (AR) exert an adverse impact on graft outcomes after kidney transplantation using organs from donation after brain-stem death (DBD) donors. Here, we examine the impact of DGF and AR on graft survival in kidney transplants using organs from donation after cardiac death (DCD) donors. We conducted a single-center retrospective study of DCD and DBD donor kidney transplants. We compared 1- and 4-year graft and patient survival rates, as well as death-censored graft survival (DCGS) rates, between the two groups using univariate analysis, and the impact of DGF and AR on graft function was compared using multivariate analysis. Eighty DCD and 206 DBD donor transplants were analyzed. Median follow-up was 4.5 years. The incidence of DGF was higher among DCD recipients (73% vs. 27%, P<0.001), and AR was higher among DBD recipients (23% vs. 9%, P<0.001). One-year and 4-year graft survival rates were similar (DCD 94% and 79% vs. DBD 90% and 82%). Among recipients with DGF, the 4-year DCGS rate was better for DCD recipients compared with DBD recipients (100% vs. 92%, P=0.04). Neither DGF nor AR affected the 1-year graft survival rate in DCD recipients, whereas in DBD recipients, the 1-year graft survival rate was worse in the presence of DGF (88% vs. 96%, P=0.04) and the 4-year DCGS rate was worse in the presence of AR (88% vs. 96%, P=0.04). Despite the high incidence of DGF, medium-term outcomes of DCD kidney transplants are comparable to those from DBD transplants. Short-term graft survival from DCD transplants is not adversely influenced by DGF and AR, unlike in DBD transplants.

Increasing the Use of Kidneys From Unconventional and High-Risk Deceased Donors.

Background/Aims: To examine the relationship of extracellular fluid (ECF) volume and osmotic excess with treatment modality, we retrospectively analyzed spontaneous body weight loss and osmotic excretion versus true body weight after kidney transplantation in peritoneal dialysis (PD) patients and preemptive transplant recipients compared with hemodialysis (HD) patients. We also examined maximum bladder volume in other transplant recipients on PD. Methods: From 2005 to 2011, 42 PD patients underwent kidney transplantation at our institution. Patients aged <12 years and cadaveric transplantations were excluded; we enrolled 27 PD patients (PD group; age 35.7 ± 14.4 years at transplantation; dialysis duration 36.5 ± 31.2 months) and 14 adult preemptive kidney transplant patients (preemptive group; age 31.7 ± 15.7 years; estimated glomerular filtration rate 8.26 ± 1.8 mL/min/1.73 m² at transplantation). From 2005 to 2006, 29 adult living-related donor kidney transplant recipients on HD support (HD group) were enrolled as controls (age 36.4 ± 11.3 years; dialysis duration 37.5 ± 55.2 months). Results: Percentage body weight loss at 1 month after transplantation was 5% from ideal body weight for the PD group (51.2 ± 14.3 to 48.6 ± 13.0 kg, p = 0.002), 5.1% for the preemptive group (56.7 ± 17.4 to 53.8 ± 16.5 kg, p = 0.0005), and 1% for the HD group (52.9 ± 12.4 to 52.1 ± 12.5 kg, p = 0.079); post-transplantation 24-h osmotic excretion was greater in the PD and preemptive groups (387.3 ± 175.7 mOsm) groups than in HD (250 ± 124 mOsm; p = 0.006. Another 69 adult living-related donor kidney transplant recipients (PD and HD support) with dialysis duration ≤5 years were examined. Mean dialysis duration differed in the HD (17.5 ± 13.1 months) and PD (29.6 ± 20.4 months, p = 0.015) groups; mean urine volume and maximum desire to void (MDV) were similar. Conclusion: ECF volume and osmotic excess occurred in the PD and preemptive groups compared with the HD group pre-transplantation. Although PD maintains MDV and residual and total urine volume, ECF volume and osmotic excess should be monitored before transplant; pre-transplant HD support should always be considered in PD and preemptive transplant patients.

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease (ESRD), off ering superior survival and quality of life compared with dialysis. Several observational studies have investigated the infl uence of hemodialysis (HD) and peritoneal dialysis (PD) on post-transplant outcomes. Objective: to assess the effect of dialysis modality prior to KT on outcomes during the fi rst two years after transplantation. Materials and methods . The study included 95 KT recipients, divided into two groups: (1) patients previously treated with PD (n = 45) and (2) patients previously treated with HD (n = 50). The groups were comparable in age, dialysis duration, and immunosuppressive therapy regimens. The mean follow-up period was 19.4 ± 6.4 months. Results . Delayed graft function (DGF) occurred less frequently in the PD group (17.8%) compared with the HD group (34%), although the diff erence did not reach statistical signifi cance (p = 0.08). Patients in the HD group required signifi cantly more rehospitalizations, with a median of 2.24 [1–3] compared to 1.9 [0–2.5] in the PD group (p = 0.01). Infectious complications were also more common among HD patients (62% vs 42%, p = 0.005). In particular, bacterial infections occurred signifi cantly more often in the HD group (63% vs 43%, p = 0.0001), whereas viral and fungal infections were detected at similar frequencies in both groups (p &gt; 0.2). The incidence of graft rejection was comparable between groups. Two-year graft survival (91% in PD vs 94% in HD, p = 0.8) and patient survival (94% in PD vs 96% in HD, p = 0.9) did not diff er signifi cantly. Likewise, serum creatinine and daily proteinuria at the end of follow-up showed no statistically signifi cant diff erences (p = 0.7 and p = 0.3, respectively). Conclusion . In this study, patients who received PD prior to transplantation showed more favorable post-transplant outcomes, including a signifi cantly lower frequency of rehospitalizations and infectious complications, as well as a trend toward reduced DGF. However, two-year graft and patient survival were similar between the PD and HD groups.

We examined the effect of haemodialysis (HD) or peritoneal dialysis (PD) on acute rejection, delayed graft function (DGF), graft and patient survival after cadaveric renal transplantation. We carried out a retrospective analysis of 325 patients (cyclosporin [CyA]-based therapy) who had their first cadaver renal transplant between January 1991 and December 1996 and followed up for a mean of 61 +/- 26 months. They were divided into three groups: HD, PD and CD (where both PD and HD was used for at least 3 months). Delayed graft function was diagnosed if the patient needed dialysis in the first week post-transplant while primary non-function (PNF) was diagnosed if the kidney never achieved function. Graft rejection was confirmed by biopsy; early acute rejection (EAR) was defined as acute rejection occurring before 90 days and late acute rejection (LAR) as one after 90 d. A total of 183 patients had PD, 117 HD and 25 CD. The mean time period in which the patients were on dialysis for PD was 24 months, HD 34.5 months and CD 50.6 months (p < 0.01). The recipients were matched for age and gender. The donor variables (age, gender and cold ischaemia time) did not differ between the groups. The mean time for the development of first acute rejection following renal transplant in each group was as follows: PD group: 68.8 d, HD group: 81.3 d and CD group: 105 d (p = 0.08). The number of patients who developed EAR was 90 (49.2%) in PD group, 51 (43.6%) in HD group and 11 (56%) in CD group (p = 0.6); the number who developed LAR was nine in PD group (4.9%), six in HD group (5.1%) and one in CD group (4%) (p = 0.9). Fifty-six patients with PD had DGF compared with 58 with HD (p = 0.01). There was no difference in the number and severity of rejection episodes or DGF based on the duration of dialysis. The 5-yr survival of patients was 79% for PD, 81% HD and 78% CD groups (p = n.s), while the graft survival for PD group was 61%, HD group 63% and CD group 74% (p = n.s). We could find no difference in the patient or graft survival between patients who had pre-transplant HD, PD or CD. There was no difference in the incidence of acute rejection episodes between the three groups of patients as well. However, we found a significantly higher rate of DGF in the HD versus PD patients.

Experience in Renal and Extrarenal Transplantation with Donation after Cardiac Death Donors with Selective Use of Extracorporeal Support

Thymoglobulin Induction Therapy in Kidney Transplant Patients Receiving Organs Donated after Cardiac Death in China: A Real-World Patient-Level Pooled Analysis of the T-DCD and Start-DCD Studies.

Background Hemodialysis (HD) and peritoneal dialysis (PD) are effective ways to treat end-stage renal disease (ERSD). This study aimed to investigate the differences in survival and the factors that influence it in patients with end-stage renal disease treated with HD or PD. Methods We retrospectively analyzed factors related to all-cause death with renal replacement therapy and compared the long-term mortality between HD and PD strategies in patients with ESRD who started HD or PD treatment in our renal HD center between January 1, 2008, and December 1, 2021. Results Overall, 1,319 patients were included, comprising 690 and 629 patients in the HD and PD groups, respectively, according to the inclusion criteria. After propensity matching, 922 patients remained, with 461 (50%) patients each in the two groups. There were no significant differences in the 1-, 2-, 3-, and 4-year mortality rates between the HD and PD groups (all p > .05). However, the 5- and 10-year mortality rates of the matched patients were 15.8%. 17.6% in the HD group and 21.0%. 27.3% in the PD group, respectively. The 5- and 10-year mortality rates were significantly lower in the HD group (all p < .05) as compared to the PD group. After matching, Kaplan–Meier curve analysis with log-rank test was performed, which showed a significant difference in the survival rates between the two groups (p = .001). Logistic multifactor regression analysis revealed that age, weight, hypertension, serum creatinine, and combined neoplasms influenced the survival rate of patients with ESRD (p < .05). In contrast, age, hypertension, parathyroid hormone (PTH), serum creatinine, and peripheral vascular diseases (PVD) influenced the survival rate of patients in the HD group (p < .05), and age and weight influenced the survival rate of patients in the PD group (p < .05). Conclusions This study found that long-term mortality rates were higher in the PD group than that in the HD group, indicating that HD may be superior to PD.

Kidney graft survival is comparable between donation after cardiac death (DCD) and donation after brain death (DBD) kidney transplantation. However, data concerning kidney function after DCD kidney transplantation are lacking. We retrospectively compared kidney function between 64 DCD and 248 DBD kidney transplant recipients. Graft function was assessed using iothalamate glomerular filtration rate at 1, 4, and 12 months, then annually. The primary endpoint was the composite of death-censored graft loss or two consecutive iothalamate glomerular filtration rates less than 50 mL/min/1.73 m² occurring within 5 years from transplantation. Secondary endpoints included death and graft loss or death. Of the 312 patients, 102 (33%) experienced the primary endpoint, 78 (25%) experienced graft loss or death, and 44 (14%) died. In multivariable Cox regression analysis, there was no difference between DCD and DBD recipients regarding the primary endpoint (relative risk [RR], 1.16; P=0.59), death (RR, 0.97; P=0.94), or graft loss or death (RR, 1.09; P=0.79). In the subgroup of 64 DCD recipients, each 10-year increase in donor age was associated with increased risk of the primary endpoint (RR, 1.51; P=0.027) with the highest risk observed for donors older than 45 years (RR, 4.81; P=0.001). Delayed graft function affected 45% of the DCD recipients but had no impact on kidney function, graft survival, or patient survival. Posttransplantation kidney function is comparable between DCD and DBD kidney transplantations. In the subgroup of DCD recipients, kidneys from donors older than 45 years may be associated with a higher risk of poor kidney function; however, this finding requires validation in a larger patient group.

BackgroundThe effect of pretransplant peritoneal dialysis (PD) or hemodialysis (HD) modality on outcomes of kidney transplantation (KT) for end-stage renal disease (ESRD) is debatable. We evaluated the outcomes these modalities in KT from donor after cardiac death (DCD).MethodsA cohort of 251 patients on HD, PD or pre-emptive who underwent first KT from DCD between January 2014 and December 2016 were prospectively analyzed to compare for outcomes on recovery of renal function, complications as well as patient and graft survival. The patients were followed till August 2017. Data on 104 HD and 98 PD were available for final comparative outcome analysis, 5 pre-emptive were analyzed as the control group.ResultsBoth HD and PD group patients were well matched for demographic and baseline characteristics. The follow-up period was 12.5 (3.0, 22.0) months in HD and 12.0 (6.0, 20.0) months in PD patients. Post-transplant renal functions between the two groups showed no differences. Among PD patients, 16 (16.3%) suffered delayed graft function, versus 19 (18.3%) in HD, with no statistical differences (p = 0.715). Complications of acute rejection, infections were comparable between the groups. The patient survival, graft survival and death-censored graft survival were similar for HD and PD after adjusting for other multiple risk factors.ConclusionsOur results indicate that outcome of first KT from DCD is not affected by pretransplant dialysis modality of PD or HD in aspects of recovery of renal function, complications as well as patient and graft survival.