The influence of dialysis modality on post-transplant outcomes
Introduction: Renal transplantation is the therapy of choice for end stage kidney disease, offering mortality risk reduction and improved morbidity over dialytic therapies. Limited data is available evaluating the effect of pre-engraftment dialysis modality on transplant outcomes. Methods: A retrospective review was conducted of all adult patients undergoing renal transplantation at Charlotte Maxeke Johannesburg Academic Hospital for the period 01/01/2006 – 31/12/2011 (n=103). Transplant outcomes were assessed by dialysis modality. c2 testing was used to compare dialysis modalities; Cox proportional hazard modelling was used to assess effect on graft outcomes. A p < 0.05 was deemed statistically significant. Results: Antecedent dialytic modality was as follows: 55 patients (53.4%) received haemodialysis (HD), 35 (34%) received peritoneal dialysis (PD), and 13 (12.6%) received a combination of both (HD+PD, defined as either modality for > 3 months). Acute rejection (AR) was documented in 43.7% of patients; 54.3% of PD patients developed AR compared to 38.2% of HD patients and 38.5% of HD+PD patients (p=0.29). No significant difference in the number of episodes of AR was detected between modality groups (p=0.44). Chronic rejection (CR) developed in 22.3% of patients overall; 21.8% of HD patients, 25.8% of PD and 15.9% of HD+PD patients (p=0.74). PD was associated with an increased risk of developing any rejection (HR=2.4, 95% CI 0.9–6.4, p=0.02). Whereas dialysis modality did not affect graft survival (for HD b= 0.57, SE=0.5, Wald=1.2, 95% CI -0.4-1.6, p=0.27; for PD b=0.58, SE=0.5, Wald = 1.4, 95% CI -0.4-1.6, p=0.24), AR was found to be associated with futuregraft loss (b=1.29, SE=0.3, Wald = 18.1, 95% CI 0.7-1.9, p<0.001).Conclusions: Antecedent PD is associated with an increased risk of graft rejection. Although AR is associated with graft loss, antecedent dialysis modality does not directly predict graft survival, likely reflecting the multifactorial nature of cumulative allograft injury.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020