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Previous Volume 344:726-731 March 8, 2001 Number 10 Next

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ABSTRACT

Background The effect on allograft survival of the transplantation of kidneys from living donors without the previous initiation of long-term dialysis is controversial.

Methods Using data from the U.S. Renal Data System, we performed a retrospective cohort study of 8481 patients who were or who were not treated by long-term dialysis before receiving a kidney transplant from a living donor. The relative rate of allograft failure for patients who received a transplant without previously undergoing long-term dialysis, as compared with patients who underwent long-term dialysis before transplantation, was assessed by proportional-hazards analysis, with adjustment for potential confounding variables, including the transplantation center and median household income. The association between the receipt of a kidney transplant from a living donor without previous dialysis ("preemptive" transplantation) and the risk of biopsy-confirmed acute rejection within six months after transplantation was evaluated by conditional logistic-regression analysis, with adjustment for the transplantation center.

Results Transplantation of a kidney from a living donor without previous long-term dialysis was associated with a 52 percent reduction in the risk of allograft failure during the first year after transplantation (rate ratio, 0.48; P=0.002), an 82 percent reduction during the second year (rate ratio, 0.18; P=0.001), and an 86 percent reduction during subsequent years (rate ratio, 0.14; P=0.001), as compared with transplantation after dialysis. The reduction in the rate of allograft failure during the first year was attenuated when adjustment was made for the timing of acute rejection within the first year (rate ratio, 0.69; 95 percent confidence interval, 0.44 to 1.10; P=0.10). Increasing duration of dialysis was associated with increasing odds of rejection within six months after transplantation (P=0.001).

Conclusions Preemptive transplantation of kidneys from living donors without the previous initiation of dialysis is associated with longer allograft survival than transplantation performed after the initiation of dialysis.

Source Information

From the Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania (K.C.M., M.M.J., H.I.F.); and the Renal-Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania (K.C.M., H.I.F.) — both in Philadelphia. Presented in part at the annual meetings of the American Society of Nephrology, Philadelphia, October 25–28, 1998, and Miami, November 1–8, 1999.

Address reprint requests to Dr. Mange at 700 Clinical Research Bldg., 415 Curie Blvd., Philadelphia, PA 19104, or at kmange{at}cceb.med.upenn.edu.

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