Introduction: To increase access for patients with delayed transplant referral, the new Kidney Allocation System (KAS) recognizes waiting time from the earlier of dialysis initiation date or listing date. We hypothesized this change would increase transplant rates for patients with long periods (≥10 years) of dialysis time (DT) prior to transplant and wished to assess the impact of prolonged DT on kidney transplant outcomes.

Methods: UNOS data from adult (age ≥18), deceased donor, first-time transplants from date to date was used in the study. Multi-organ transplant listings and recipients were excluded. Post-transplant graft survival was calculated using Kaplan-Meier curves and a log-rank test.

Results: Prior to the new KAS, patients with increased category of dialysis times (DT) at time of listing were progressively less likely to be transplanted and more likely to die or be delisted (Table 1). Compared with patients with <5 years of DT, those with ≥10 years DT tended to be younger and were more likely to be of black ethnicity. Patients without dialysis exposure had better graft survival than patients with any DT (p<0.001, Fig 1). Patients with 10-14, 15-19, and ≥20 years of DT had similar graft survival (p = 0.69). Graft failure within 30 days was progressively more likely with increased DT (p<0.001). In multi-variable analysis, increased DT was progressively associated with increased hazard of graft failure (Table 2). More longest-term dialysis patients were transplanted the year after versus year before KAS (Table 3).Conclusions: Prolonged pre-operative DT is associated with progressively decreased graft survival after kidney transplant although > 20 years was not significantly inferior to other dialysis categories. KAS enhanced transplant access for patients with long dialysis times.

CITATION INFORMATION: Aufhauser Jr D, Peng A, Murken D, Concors S, Levine M. Prolonged Dialysis Prior to Renal Transplantation. Am J Transplant. 2017;17 (suppl 3).

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