Clinical transplantation 2018 04 15() e13260 doi 10.1111/ctr.13260
The new Kidney Allocation System (KAS) prioritizes patients based on date of dialysis initiation or wait-listing, whichever is earlier. We hypothesized that this change would increase transplant rates for patients with prolonged pre-transplant dialysis times (DT) and aimed to assess the impact of prolonged DT on post-transplant outcomes.
We used United Network for Organ Sharing registry data to assess outcomes for patients added to the renal transplant waitlist from Jan 1 1998 – Dec 31 2010 and patients transplanted from Jan 1 1998 – Dec 3 2012.
Compared with patients transplanted preemptively, patients with <5 years, 5-9 years, and ≥10 years DT had progressively decreased graft and patient survival (p<0.001). The rates of short-term complications including delayed graft function, graft loss within 30 days, and patient death within 30 days were significantly higher in cohorts with ≥10 years DT than in cohorts with less DT (p<0.001). CONCLUSIONS
Patients with pre-transplant DT of ≥10 years had worse outcomes than patients pre-emptively transplanted or transplanted with shorter DT. Durations of dialysis dependence beyond 10 years were associated with further deterioration in short-term but not long-term post-transplant outcomes. This article is protected by copyright. All rights reserved.