NDT Advance Access originally published online on November 9, 2005
Nephrology Dialysis Transplantation 2006 21(3):776-783; doi:10.1093/ndt/gfi248
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations
1 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, 2 Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, 4 Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia and 3 Renal Department, Middlemore Hospital, Otahuhu, Auckland, New Zealand
Correspondence and offprint requests to: Professor David Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia. Email: david_johnson{at}health.qld.gov.au
Background. There is limited information about the outcomes of patients commencing peritoneal dialysis (PD) after failed kidney transplantation. The aim of the present study was to compare patient survival, death-censored technique survival and peritonitis-free survival between patients initiating PD after failed renal allografts and those after failed native kidneys.
Methods. The study included all patients from the ANZDATA Registry who started PD between April 1, 1991 and March 31, 2004. Times to death, death-censored technique failure and first peritonitis episode were examined by multivariate Cox proportional hazards models. For all outcomes, conditional risk set models were utilized for the multiple failure data, and analyses were stratified by failure order. Standard errors were calculated by using robust variance estimation for the cluster-correlated data.
Results. In total, 13 947 episodes of PD were recorded in 23 579 person-years. Of these, 309 PD episodes were started after allograft failure. Compared with PD patients who had never undergone kidney transplantation, those with failed renal allografts were more likely to be younger, Caucasian, New Zealand residents and life-long non-smokers with lower body mass index (BMI), poorer initial renal function and a longer period from commencement of the first renal replacement therapy to PD. On multivariate analysis, PD patients with failed kidney transplants had comparable patient mortality [weighted hazards ratio (HR) 1.09, 95% confidence interval (CI) 0.81–1.45, P = 0.582], death-censored technique failure (adjusted HR 0.91, 95% CI 0.75–1.10, P = 0.315) and peritonitis-free survival (adjusted HR 0.92, 95% CI 0.72–1.16, P = 0.444) with those PD patients who had failed native kidneys. Similar findings were observed in a subset of patients (n = 5496) for whom peritoneal transport status was known and included in the models as a covariate.
Conclusion. Patients commencing PD after renal allograft failure experienced outcomes comparable with those with failed native kidneys. PD appears to be a viable option for patients with failed kidney allografts.
Keywords: failed renal allograft; patient survival; peritonitis; technique survival; transplantation; treatment modality