Short UK Dialysis Does Not Significantly Impact on Live Donor Kidney Allograft Survival.

A. Bentall,^1,2 M. Jesky,^1,2 R. Borrows,^1,2 R. Johnson,³ S. Ball.^1,2

¹Department of Nephrology, University Hospitals Birmingham, Birmingham, United Kingdom
²School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
³NHSBT, Bristol, United Kingdom.

Meeting: 2016 American Transplant Congress

Abstract number: 63

Keywords: Donation, Graft survival, Kidney transplantation, Sensitization

Session Information

Session Name: Concurrent Session: Policy and Practice: Implications for Long Term Outcomes

Session Type: Concurrent Session

Date: Sunday, June 12, 2016

Session Time: 2:30pm-4:00pm

Presentation Time: 2:42pm-2:54pm

Location: Room 312

Background. The survival advantage of pre-emptive transplantation (Pre-empTx) in live donor kidney transplantation (LDKTx) was reported by Meier-Kreische (Kidney International, 2000). Dialysis practices differ internationally and immunosuppressive regimes have advanced. The aim of this study was to examine the effect of dialysis time on allograft survival in UK LDKTx, including an assessment of allograft survival (GS) between compatible (CTx) and antibody incompatible transplants (AiT) donors.

Methods. Data from NHSBT for LDKTx recipients in the UK were analysed between 2001 and 2013 including 9755 patients, from 8970 were adults and had available dialysis data. These data were analysed for both GS and composite outcomes (combined death or graft failure). No meaningful differences were found in using a competing risk regression model. Dialysis time (DiT) was categorised into Pre-Tx, <1yr, 1-2 yrs, and >2yrs dialysis. AiT (n=946) were grouped as HLA incompatible (HLAi, n=473) and blood group ABO incompatible (ABOi, n=473). Paired Exchange recipients (PrEx, n=278) and CTx (n=7746) were also analysed in this study.

Results. Transplant groups differed significantly with respect to donor age, recipient age, calculated reaction frequency at transplant, HLA mismatches. The risk of graft failure (GF) of LDKTx compared to Pre-empTx increased with more DiT, but only after 1 year of dialysis in the whole cohort (<1yr DiT HR 1.05,p=0.73, 1-2yr HR 1.25 p=0.12, >2yr HR 1.74 p<0.01). Overall Death Censored GS at 5yr was Pre-empTx 92.7%, 0-1yr 92.3%, 1-2yr 90.0%, 2-4yr 87.2% and >4yr 83.6%. In multivariate Logistic Regression adjusted risk of GF compared to CTKx, ABOi and PrEx were at no increased risk of GF (HR 1.02,p=0.89 and HR0.70, p=0.13 respectively), however HLAi had a HR 1.46 (p<0.01) increased risk of graft failure. Death Censored GS at 5yr was ABOi 88.5%, HLAi 78.3% and CTx 91.1%.

Conclusion.A short time (<1year)on dialysis does not reduce GS in LDKTx in the UK. Compared to CTx, AiT recipients have lower graft survival, however reduced dialysis time was associated with improved GS in ABOi and HLAi. These data help clinicians make informed decision on timing of LDKTx, particularly with AiT recipient: donor pairs.

CITATION INFORMATION: Bentall A, Jesky M, Borrows R, Johnson R, Ball S. Short UK Dialysis Does Not Significantly Impact on Live Donor Kidney Allograft Survival. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Bentall A, Jesky M, Borrows R, Johnson R, Ball S. Short UK Dialysis Does Not Significantly Impact on Live Donor Kidney Allograft Survival. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/short-uk-dialysis-does-not-significantly-impact-on-live-donor-kidney-allograft-survival/. Accessed November 22, 2024.

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