Dialysis prior to living donor kidney transplantation and rates of acute rejection

Nephrol Dial Transplant. 2003 Jan;18(1):172-7. doi: 10.1093/ndt/18.1.172.


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.

MeSH terms

  • Acute Disease
  • Adult
  • Continental Population Groups
  • Female
  • Graft Rejection / epidemiology*
  • Graft Rejection / pathology
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Kidney Transplantation / physiology
  • Living Donors*
  • Male
  • Multivariate Analysis
  • Patient Selection
  • Proportional Hazards Models
  • Registries
  • Renal Dialysis* / adverse effects
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • United States