Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors.

Background: The effect on allograft survival of the transplantation of kidn eys from living donors without the previous initiation of long-term dialysi s is controversial. Methods: Using data from the U.S. Renal Data System, we performed a retrosp ective cohort study of 8481 patients who were or who were not treated by lo ng-term dialysis before receiving a kidney transplant from a living donor. The relative rate of allograft failure for patients who received a transpla nt without previously undergoing long-term dialysis, as compared with patie nts who underwent long-term dialysis before transplantation, was assessed b y proportional-hazards analysis, with adjustment for potential confounding variables, including the transplantation center and median household income . The association between the receipt of a kidney transplant from a living donor without previous dialysis ("preemptive'' transplantation) and the ris k of biopsy-confirmed acute rejection within six months after transplantati on was evaluated by conditional logistic-regression analysis, with adjustme nt for the transplantation center. Results: Transplantation of a kidney from a living donor without previous l ong-term dialysis was associated with a 52 percent reduction in the risk of allograft failure during the first year after transplantation (rate ratio, 0.48; P=0.002), an 82 percent reduction during the second year (rate ratio , 0.18; P=0.001), and an 86 percent reduction during subsequent years (rate ratio, 0.14; P=0.001), as compared with transplantation after dialysis. Th e reduction in the rate of allograft failure during the first year was atte nuated when adjustment was made for the timing of acute rejection within th e first year (rate ratio, 0.69; 95 percent confidence interval, 0.44 to 1.1 0; P=0.10). Increasing duration of dialysis was associated with increasing odds of rejection within six months after transplantation (P=0.001). Conclusions: Preemptive transplantation of kidneys from living donors witho ut the previous initiation of dialysis is associated with longer allograft survival than transplantation performed after the initiation of dialysis. ( N Engl J Med 2001;344:726-31.) Copyright (C) 2001 Massachusetts Medical Soc iety.