  
Kidney transplants fare best when performed before dialysis initiated
Last Updated: 2001-03-09 12:35:19 EST (Reuters Health)
By Will Boggs, MD
WESTPORT, CT (Reuters Health) - Renal allografts from living donors survive longer when transplanted before the recipient has undergone renal dialysis, according to a report in the March 8th issue of The New England Journal of Medicine.
The authors explain that the effect of long-term dialysis on survival rates of kidneys from living donors is controversial. To address this issue, Dr. Kevin C. Mange and colleagues from the University of Pennsylvania in Philadelphia used data from the US Renal Data System
Compared with patients who received transplants after being on dialysis, patients who had never undergone dialysis experienced a 34% reduction in allograft failure during the first year after transplantation, a 44% reduction during the second year, and a 62% reduction thereafter, the authors report.
The magnitude of benefit was even greater after adjustment for the cause of the kidney disease, the racial relationship between donor and recipient, and the presence or absence of delayed allograft function, the researchers note. Only the adjustment for acute graft rejection attenuated the effect of transplanting before dialysis, the report indicates, and that only slightly.
Also, the risk of allograft failure within 6 months increased with increasing dialysis duration, the investigators found.
"As physicians, we need to identify patients with 'kidney problems' and refer them to a nephrologist sooner than what is presently happening in the US," Dr. Mange told Reuters Health. "For example, approximately 25% of recipients of kidneys from living donors receive their organ prior to dialysis initiation. This proportion should increase if patients are referred early in the course of [end-stage renal disease]."
"Once a patient is in an inevitable course to ESRD," Dr. Mange advised, "then that person should be referred. Because there is a potential benefit to patients, delaying referral to a nephrologist or to a transplant center is not in the best interests of the patient."
N Engl J Med 2001;344:726-731.
-Westport Newsroom 203 319-2700
|
Copyright 2001 Reuters Limited. All rights reserved. Republication or redistribution of Reuters Limited content, including by framing or similar means, is expressly prohibited without prior written consent of Reuters Limited. Reuters Limited shall not be liable for any error or delays in the content, or for any actions taken in reliance thereon.
|
|
 Back To Transplant Wellness Center
| 
