Previous studies of renal transplant success from deceased donors revealed a modestly increased graft survival rate (approximately 10 percent) in patients who had not received long-term dialysis before transplantation. Of late, living donors have become the largest source of renal transplants, given the shortage of available organs from deceased donors.
Mange and colleagues report on an analysis of the 9,130 adult recipients of living-donor renal transplants identified by the U.S. Renal Data System from January 1994 to June 1997. Excluded from the analysis were 649 patients who had prior transplantation or an unknown status for prior dialysis. Approximately 73 percent of patients had some dialysis treatment before transplantation. No significant demographic or clinical differences were seen between those who did and those who did not receive dialysis before transplantation. Over a mean follow-up period of 406 days after transplantation, the total incidence of graft failure was 5 percent.
Renal transplantation without prior dialysis was associated with a decreased rate of graft failure. In the first year after transplant, the graft failure rate was reduced 52 percent, and this reduction was greater than 80 percent in the second and third years after transplant. The number of transplants performed at each center and the economic status of the graft recipients were factors that did not alter the outcomes.
A lower rate of acute graft rejection accounted for most of the protective effect of no prior dialysis in transplant recipients during the first year after surgery, but it did not explain the reduced failure rates in subsequent years. Increasing the length of dialysis before transplantation caused a progressive increase in subsequent graft failure.
The authors conclude that preemptive renal transplantation from living donors before dialysis was associated with an increased graft survival rate. Interestingly, it was noted by the authors that improved immune function in dialyzed patients may partly explain their increased incidence of graft rejection after transplantation.