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Comparison between two dialytic populations undergoing renal transplantation
G Triolo1, G P Segoloni, M Salomone
1Nephro-Urology Institute, University of Torino, Italy.
Insights
Renal transplantation outcomes are comparable between continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis patients. This study found similar patient and graft survival rates, rejection episodes, and hospitalization rates in matched groups.
Area of Science:
- Nephrology
- Transplantation Immunology
Background:
- Outcomes of renal transplantation in patients on continuous ambulatory peritoneal dialysis (CAPD) remain debated.
- Clinical and demographic differences complicate direct comparisons with hemodialysis (HD) patients.
Purpose of the Study:
- To compare renal transplant outcomes between CAPD and HD patients using a matched case-control design.
- To analyze graft and patient survival, rejection episodes, and clinical parameters in homogeneous patient groups.
Main Methods:
- A case-control study matched 18 CAPD patients (Group A) with 18 HD patients (Group B).
- Matching criteria included age, acute tubular necrosis, and Cyclosporine A regimen.
- Key outcomes assessed included patient/graft survival, rejection episodes, serum creatinine, infection rates, and lipid profiles.
Main Results:
- No significant differences were observed in patient survival, graft survival, rejection episodes, serum creatinine levels, or hospitalization rates at 1 year between Group A and Group B.
- Group A (CAPD) had a higher incidence of infections (12 episodes) compared to Group B (HD) (3 episodes).
- Trends showed increased post-transplant cholesterol and decreased triglycerides in both groups, with no significant changes in body weight.
Conclusions:
- Renal transplantation outcomes are comparable between CAPD and HD patients when matched for key clinical characteristics.
- Infection rates represent a notable difference, with CAPD patients experiencing more episodes.
- The study supports the viability of renal transplantation for CAPD patients with similar clinical profiles to HD patients.
Abstract:
The outcome of renal transplantation in CAPD patients is still controversial since age and clinical differences often make comparison with hemodialysis patients difficult. The aim of this study was to analyse two homogeneous groups of patients, on CAPD and on hemodialysis. 18 CAPD (Group A) and 18 hemodialysis patients (Group B) were selected for a case-control analysis, matched for age, presence of acute tubular necrosis and Cyclosporine A regimen. Group A and B were not different for male/female ratio, donor age, HLA-Dr mismatches, arterial pressure, cold ischemia, or follow-up. Patient, graft survival and number of rejection episodes did not differ significantly at 1 year; serum creatinine at 6 and 12 months and CyA doses at 1 and 6 months were not different; hospitalization rates for first and subsequent admissions did not differ. Infection-free patients were 9/18 in Group A and 15/18 in Group B, with 12 episodes in Group A and 3 in Group B. Post transplant cholesterol levels showed a trend to increase in both groups and triglycerides levels to a decrease; differences in pre and post transplant in body weight were not significant at 12 months. In conclusion, the outcome of transplantation in CAPD patients is not significantly different from that in hemodialysis patients with similar clinical characteristics.