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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Kidney transplantation for patients on long-term hemodialysis
H Ushigome1, K Sakai, T Suzuki
1Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan. ushi@koto.kpu-m.ac.jp
Insights
Patients on hemodialysis (HD) for over 10 years experience worse survival and graft outcomes after kidney transplantation. Long-term dialysis negatively impacts patient and graft survival post-transplant.
Area of Science:
- Nephrology
- Transplantation Medicine
- Clinical Outcomes Research
Background:
- Long-term hemodialysis (HD) patients face significant morbidity from complications and comorbidities.
- Dialysis duration is a critical factor influencing outcomes for kidney transplant recipients.
- Understanding the impact of extended dialysis is crucial for improving patient and graft survival.
Purpose of the Study:
- To evaluate the effect of pre-transplant dialysis duration on patient and graft survival after kidney transplantation.
- To compare outcomes between patients on long-term HD (>10 years) and short-term HD (<10 years).
Main Methods:
- Retrospective analysis of 436 kidney transplant recipients between 1987 and 2007.
- Patients were categorized into long-term HD (>10 years, n=39) and short-term HD (0-9.8 years, n=397) groups.
- Comparison of patient and graft survival rates at 1, 5, and 10 years post-transplantation.
Main Results:
- Significantly lower patient survival rates at 1, 5, and 10 years for the long-term HD group (58.4% at 10 years) compared to the short-term HD group (93.1% at 10 years).
- Graft survival rates were also significantly lower in the long-term HD group (33.4% at 10 years) versus the short-term HD group (80.4% at 10 years).
- P-values for both patient and graft survival differences were statistically significant (P = .0034 and P = .0026, respectively).
Conclusions:
- Pre-transplant dialysis exceeding 10 years is associated with poorer patient survival.
- Extended duration of hemodialysis negatively impacts long-term kidney graft survival.
- These findings highlight the detrimental effects of prolonged dialysis on transplant success.
Abstract:
Patients surviving more than 10 years on hemodialysis (HD) are at risk of developing serious morbidity from unrelated conditions and from the many complications of long-term dialysis, such as cardiovascular disease, cerebrovascular disease, malignant tumors ectopic vascular calcification, diabetes mellitus, and disuse atrophy of the bladder. Long-term dialysis affects transplant patient outcomes and long-term graft survival. We analyzed 436 patients who underwent kidney transplantations between January 1987 and December 2007 to determine the impact of long-term dialysis on kidney transplant outcomes. The 39 patients who had been treated pretransplantation with dialysis for more than 10 years had an average length of dialysis treatment of 15.8 years (range, 10.0-32.5 years); they were denoted as the long-term hemodialysis group. The remaining 397 recipients showed an average of 3.7 years period of end-stage renal disease (ESRD) (range, 0-9.8, years; short-term hemodialysis group). There were significant differences in patient survival rates between the 2 groups: 93.2% vs 98.6%, at 1 year; 79.3% vs 95.4% at 5 years; and 58.4% vs 93.1% at 10 years (P = .0034). Also, graft survival was significantly different between the 2 groups: 89.2% vs 95.8% at 1 year; 60.4% vs 88.5% at 5 years; and 33.4% vs 80.4% at 10 years (P = .0026). Our results suggest that dialysis treatment for more than 10 years produces negative effects on post-transplantation patient and graft survival.
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