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Declining trend of preemptive kidney transplantation and impact of pretransplant dialysis: a Korean nationwide prospective cohort study

Authors
 Jeong-Hoon Lim  ;  Yena Jeon  ;  Sang-Ho Lee  ;  Yu Ho Lee  ;  Jung Pyo Lee  ;  Jaeseok Yang  ;  Myoung Soo Kim  ;  Hee-Yeon Jung  ;  Ji-Young Choi  ;  Sun-Hee Park  ;  Chan-Duck Kim  ;  Yong-Lim Kim  ;  Jang-Hee Cho  ;  Korean Organ Transplantation Registry Study Group 
Citation
 TRANSPLANT INTERNATIONAL, Vol.34(12) : 2769-2780, 2021-12 
Journal Title
TRANSPLANT INTERNATIONAL
ISSN
 0934-0874 
Issue Date
2021-12
MeSH
Cohort Studies ; Graft Survival ; Humans ; Kidney Failure, Chronic* / surgery ; Kidney Transplantation* ; Prospective Studies ; Renal Dialysis ; Republic of Korea ; Retrospective Studies ; Treatment Outcome
Keywords
living donor kidney transplantation ; mortality ; preemptive kidney transplantation ; renal outcome ; trends
Abstract
We evaluated the temporal trend of preemptive kidney transplantation (KT) and the effect of pretransplant dialysis duration on post-transplant outcomes. This was a nationwide cohort study of the first-time 3392 living donor KT (LDKT) recipients (2014-2019). The annual changes in proportion of preemptive KT, factors associated with preemptive KT, and post-transplant outcomes were analyzed. Preemptive KT was performed in 816 (24.1%) patients. Annual trend analysis revealed gradual decrease in preemptive KT over time (P = 0.042). Among the underlying causes of preemptive KT, the proportion of diabetes increased and that of glomerulonephritis decreased during the study period. Glomerulonephritis as the primary renal disease was a predictor of preemptive KT. Patients with pretransplant dialysis >6 months showed increased graft failure risk than preemptive KT in the subdistribution of hazard model for competing risk (adjusted hazard ratio [aHR], 2.53; 95% confidence interval [CI], 1.09-5.87; P = 0.031) and in propensity score-matched analysis (aHR, 2.45; 95% CI, 1.02-5.92; P = 0.034); however, pretransplant dialysis ≤6 months showed comparable graft survival with preemptive KT in both analyses. Preemptive KT declined over successive years, associated with an increase in diabetes and a decrease in glomerulonephritis as underlying causes of KT. Short period of dialysis less than 6 months does not affect graft survival compared with preemptive KT; however, longer dialysis decreases graft survival.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/tri.14135
DOI
10.1111/tri.14135
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Yang, Jaeseok(양재석)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192397
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