Impact of adequate dialysis before transplantation on development of chronic renal allograft dysfunction in 3-year...

Transplantation is the preferred treatment modality for many patients with end-stage renal diseases. Despite all the efforts, allograft dysfunction remains the most important cause of graft loss. Finding new factors that improve graft survival is mandatory.

This prospective study included 93 patients transplanted between April 1999 and July 2000. The duration of dialysis prior to transplantation was analyzed with respect to the values before and up to 3 years posttransplantation, including blood urea nitrogen (BUN), creatinine, and blood pressure (BP) using 1-month intervals and triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein at 3-month intervals. In this study, graft dysfunction was defined as serum creatinine >1.8 mg/dL. Hypertension was defined as BP > 140/90 on two occasions or treatment with antihypertensive medications. Patients in the hypertensive group were divided into controlled versus uncontrolled hypertensives.

The mean BUN and creatinine values of the patients prior to transplantation was 90 +/- 30 and 10.4 +/- 4, respectively. The patients had been on dialysis for an average of 4.7 years. Development of renal allograft dysfunction did not show any relationship to the duration of dialysis ptt. Patients with higher BUN and creatinine levels before transplantation experienced more episodes of renal allograft dysfunction in the 3-year posttransplant period (P < .05 for both BUN and creatinine). The relationship between BUN and creatinine prior to transplantation and risk of renal allograft dysfunction was more powerful among the group of uncontrolled hypertensives.

Intensive dialysis prior to transplantation may exert positive effects on long-term graft function and survival.