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Original ArticlesRenal Transplantation
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Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

Norihiko Goto, Manabu Okada, Takayuki Yamamoto, Makoto Tsujita, Takahisa Hiramitsu, Shunji Narumi, Akio Katayama, Takaaki Kobayashi, Kazuharu Uchida and Yoshihiko Watarai
CJASN March 2016, 11 (3) 497-504; DOI: https://doi.org/10.2215/CJN.08670815
Norihiko Goto
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Manabu Okada
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Takayuki Yamamoto
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Makoto Tsujita
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Takahisa Hiramitsu
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Shunji Narumi
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Akio Katayama
†Department of Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan; and
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Takaaki Kobayashi
‡Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
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Kazuharu Uchida
†Department of Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan; and
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Yoshihiko Watarai
*Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan;
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Abstract

Background and objectives Evidence regarding the differences in clinical outcomes after preemptive kidney transplantation (PKT) and non-PKT in Japan is lacking.

Design, setting, participants, & measurements We conducted a retrospective cohort study at a single center in Japan. Consecutive patients ages >18 years old who had received a kidney transplant from a living donor between November of 2001 and December of 2013 at our institution (n=786) were enrolled. The primary study outcome was the occurrence of clinical events before the end of 2014. Clinical events were defined as any of the following: death with functioning graft (DWFG), graft loss, or post–transplant cardiovascular disease (CVD).

Results The median follow-up period was 61.0 (35.3–94.0) months. PKT was performed in 239 patients (30.4%). Clinical events occurred in 78 (9.9%). In the Cox proportional hazard model for univariate analysis, factors found to be associated with higher risk of clinical events included older age, men, ABO incompatibility, longer dialysis duration, diabetes, pretransplant CVD, and large ventricular mass index. PKT was associated with lower risk. Clinical event rate in patients who received a PKT was 3.3% compared with 10.8%, 11.1%, 10.4%, 10.2%, 16.7%, and 16.2% among patients who were on dialysis for <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, and ≥5 years before transplant, respectively (P=0.002). The multivariate analysis showed that ABO incompatibility (hazard ratio [HR], 2.98; 95% confidence interval [95% CI], 1.89 to 4.71), duration of dialysis per year (HR, 1.07; 95% CI, 1.03 to 1.11), and diabetes (HR, 3.54; 95% CI, 2.05 to 6.12) were only three independent risk factors for the incidence of clinical events.

Conclusions Even in Japan, where the long-term outcomes of patients on hemodialysis are excellent, PKT could be beneficial to reduce DWFG, graft loss, and post-transplant CVD.

  • living donor
  • cohort studies
  • humans
  • kidney transplantation
  • living donors
  • proportional hazards models
  • renal dialysis
  • risk factors
  • Received August 14, 2015.
  • Accepted November 18, 2015.
  • Copyright © 2016 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 11 (3)
Clinical Journal of the American Society of Nephrology
Vol. 11, Issue 3
March 07, 2016
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Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort
Norihiko Goto, Manabu Okada, Takayuki Yamamoto, Makoto Tsujita, Takahisa Hiramitsu, Shunji Narumi, Akio Katayama, Takaaki Kobayashi, Kazuharu Uchida, Yoshihiko Watarai
CJASN Mar 2016, 11 (3) 497-504; DOI: 10.2215/CJN.08670815

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Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort
Norihiko Goto, Manabu Okada, Takayuki Yamamoto, Makoto Tsujita, Takahisa Hiramitsu, Shunji Narumi, Akio Katayama, Takaaki Kobayashi, Kazuharu Uchida, Yoshihiko Watarai
CJASN Mar 2016, 11 (3) 497-504; DOI: 10.2215/CJN.08670815
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Keywords

  • living donor
  • cohort studies
  • humans
  • kidney transplantation
  • Living Donors
  • Proportional Hazards Models
  • renal dialysis
  • risk factors

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