Pretransplant Dialytic Modality and Outcomes of Kidney Transplantation: Analysis of the Nationwide Data from Thailand Transplant Registry
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Abstract
Background: Kidney transplantation (KT) is the best option for kidney replacement therapy. The data on the impact of pretransplant dialytic modality on outcomes of KT remain conflicting. The aim of the present study was to evaluate the association between pretransplant dialytic modality and outcomes of KT.
Methods: This is a retrospective cohort study of 8,097 patients that received KT between 1987 to 2020 from Thailand transplant registry database. There were 5,038 patients that met the inclusion criteria, 634 received peritoneal dialysis (PD) and 4,404 received hemodialysis (HD). The primary outcomes were 1-year, 5-year and 10-year patient and death-censored graft survival (DCGS). The secondary outcomes were delayed graft function (DGF) and acute rejection.
Results: There were no differences in patient survival (PD vs. HD, adjusted hazard ratio 1.23 (0.77-1.96), p=0.391) and DCGS (1.50 (0.95-2.39), p=0.083). Overall, the PD group experienced lower incidence of DGF (adjusted odds ratio 0.71 (0.56-0.91), p=0.006) which was more pronounced in the subgroup of decreased donor KT (0.69 (0.53-0.89), p=0.004). Lower incidence of DGF was also observed among deceased donor KT recipients that received maintenance HD for <12 months. The incidence of acute rejection was comparable between the two groups (adjusted odds ratio 0.47 (0.17-1.32), p=0.149).
Conclusion: There were no associations between pretransplant dialytic modality with patient and graft survival and the incidence of acute rejection. The incidence of DGF was significantly lower in the recipients that received PD especially in the subgroup that underwent deceased donor KT.
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