PATIENT SURVIVAL AFTER RENAL-TRANSPLANTATION - I - THE IMPACT OF DIALYSIS PRETRANSPLANT

Patients on dialysis and recipients of renal transplants have higher m ortality than individuals without kidney disease. In this study we eva luated the possible impact of dialysis therapy before transplantation on patient survival after the transplant. This analysis includes all o f the patients who received a cadaveric renal transplant at The Ohio S tate University from 1984 to 1991 and who remained alive with function ing grafts for at least six months after the transplant (N = 523). Aft er a follow-up of 84 +/- 14 months, 28% of the patients died and 23% l ost their grafts. By multivariate analysis, reduced patient survival ( censored at the time of graft loss) correlated with these pre-transpla nt variables: Older age (P < 0.0001), the presence of diabetes (P = 0. 0002), smoking (P = 0.009), and the length of time on dialysis (P = 0. 0002). Thus, 7% of patients who were never dialyzed, 23% of those dial yzed for less than three years, and 44% of patients dialyzed for great er than or equal to three years died post-transplant. By Cox regressio n, patient survival months correlated with time on dialysis pre-transp lant (P = 0.0003). The type of dialysis (CAPD vs. hemodialysis) did no t correlate with patient survival. Graft survival, censored for patien t death, did not correlate with any of these pre-transplant variables. The relationship between time on dialysis and patient mortality is du e to at least two factors: (1) transplant recipients who had dialysis for greater than or equal to 3 years had higher mortality due to infec tions (22%) than those who had dialysis for < 3 years (3%, P = 0.01 by X-2); and (2) increasing time on dialysis increases the prevalence of both left ventricular hypertrophy (P = 0.008) and cardiomegaly (P = 0 .004), and these relationships are statistically independent of other factors that also correlate with the prevalence of cardiovascular dise ase. In conclusion, increased time on dialysis prior to renal transpla ntation is associated with decreased survival of transplant recipients .