Kidney allografts often last longer when they are transplanted in patients who have not been undergoing long-term dialysis, according to researchers at the University of Pennsylvania.
"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," Kevin C. Mange, MD, and colleagues reported on March 8 in The New England Journal of Medicine (2001;344:726-731).
The authors studied 8481 patients who were or were not treated by long-term dialysis before receiving a kidney transplant from a living donor. Transplantation without previous long-term dialysis was associated with a 52% reduction in the risk of allograft failure during the first year after transplantation, an 82% reduction in the second year, and an 86% reduction in subsequent years compared with transplants in patients who had been receiving dialysis, the authors reported. By three years after transplantation, allograft survival was 90% in the patients receiving preemptive transplantation and 81% in the patients who had been on dialysis.
The authors also found that, within six months of transplantation, the odds of allograft failure increased with the length of time a patient had received dialysis before transplantation.
Dr. Mange and colleagues concluded that the "reduction in the rate of acute allograft rejection suggests that preemptive transplantation may modulate immune mechanisms that shorten allograft survival."
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