Nephrol Dial Transplant (2003) 18: 172-177
© 2003 European Renal Association-European Dialysis and Transplant Association
Dialysis prior to living donor kidney transplantation and rates of acute rejection*,
1 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and Renal-Electrolyte and Hypertension Division, Department of MedicineUniversity of Pennsylvania Medical Center and 2 Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, Philadelphia, USA
Background. The relationship between transplantation prior to chronic dialysis initiation and the pattern of acute rejection of kidneys from living donors (LDKT) has not been fully explored.
Methods. Using data provided by the United States Renal Data System, we performed a retrospective cohort study fitting multivariate proportional hazards models to characterize the association of chronic use of dialysis prior to transplantation [non-pre-emptive LDKT (non-PLDKT)] and acute rejection, and to examine if this association varies throughout the first year.
Results. Non-PLDKT was associated with a 2.5-fold higher rate of biopsy-confirmed rejection during the first month [adjusted HR 2.5, 95% confidence interval (1.85–3.33)], compared with no dialysis prior to transplantation. Increasing duration of pre-transplant dialysis was associated with increasing rate of biopsy-confirmed acute rejection during the first month (P=0.001 for trend). Over the first year, there was a diminishing relationship between non-PLDKT and acute rejection: 2.5-, 2.22-, 2.13- and 1.78-fold elevation in the episodes of biopsy-confirmed acute rejection during the first, second, third through to the sixth and seventh through to the twelfth month post-transplant, respectively (P=0.05 for trend).
Conclusions. The waning of the association of non-PLDKT with acute rejection over time supports the hypothesis that dialysis exposure prior to transplantation may modulate the immune system to increase the rates of acute rejection.
Keywords: dialysis; kidney; rejection; transplantation
Correspondence and offprint requests to: Dr Kevin C. Mange, 700 Clinical Research Building, 423 Curie Boulevard, University of Pennsylvania, Philadelphia, PA 19104, USA. Email: kmange{at}cceb.med.upenn.edu
*Presented in part at the annual meeting of the American Society of Nephrology, San Francisco, CA, October 13–17, 2001.
The interpretation and reporting of these data are the responsibility of the authors and should in no way be seen as reflecting the official policy or interpretation of the US Government.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  F. G. Pradel, R. Jain, C. D. Mullins, J. A. Vassalotti, and S. T. Bartlett A Survey of Nephrologists' Views on Preemptive Transplantation Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1837 - 1845. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Chelamcharla, B. Javaid, B. C. Baird, and A. S. Goldfarb-Rumyantzev The outcome of renal transplantation among systemic lupus erythematosus patients Nephrol. Dial. Transplant., December 1, 2007; 22(12): 3623 - 3630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Goldfarb-Rumyantzev, J. F. Hurdle, J. Scandling, Z. Wang, B. Baird, L. Barenbaum, and A. K. Cheung Duration of end-stage renal disease and kidney transplant outcome Nephrol. Dial. Transplant., January 1, 2005; 20(1): 167 - 175. [Abstract] [Full Text] [PDF]
|
|