Pretransplant Dialysis and Preemptive Transplant in Living Donor Kidney Recipients.
dialysis
kidney transplantation
living donor
preemptive transplant
renal dialysis
Journal
Kidney360
ISSN: 2641-7650
Titre abrégé: Kidney360
Pays: United States
ID NLM: 101766381
Informations de publication
Date de publication:
30 06 2022
30 06 2022
Historique:
received:
02
12
2021
accepted:
07
04
2022
entrez:
18
7
2022
pubmed:
19
7
2022
medline:
20
7
2022
Statut:
epublish
Résumé
The optimal timing of dialysis access placement in individuals with stage 5 CKD is challenging to estimate. Preemptive living donor kidney transplant (LDKT) is the gold-standard treatment for ESKD due to superior graft survival and mortality, but dialysis initiation is often required. Among LDKT recipients, we sought to determine which clinical characteristics were associated with preemptive transplant. Among non-preemptive LDKT recipients, we sought to determine what dialysis access was used, and their duration of use before receipt of living donor transplant. We retrospectively extracted data on 569 LDKT recipients, >18 years old, who were transplanted between January 2014 and July 2019 at UCSF, including dialysis access type (arteriovenous fistula [AVF], arteriovenous graft [AVG], peritoneal dialysis catheter [PD], and venous catheter), duration of dialysis, and clinical characteristics. Preemptive LDKT recipients constituted 30% of our cohort and were older, more likely to be White, more likely to have ESKD from polycystic kidney disease, and less likely to have ESKD from type 2 diabetes. Of the non-preemptive patients, 26% used AVF, 0.5% used AVG, 32% used peritoneal catheter, 11% used venous catheter, and 31% used more than one access type. Median (IQR) time on dialysis for AVF/AVG use was 1.86 (0.85-3.32) years; for PD catheters, 1.12 (0.55-1.92) years; for venous catheters, 0.66 (0.23-1.69) years; and for multimodal access, 2.15 (1.37-3.72) years. We characterized the dialysis access landscape in LDKT recipients. Venous catheter and PD were the most popular modality in the first quartile of dialysis, and patients using these modalities had shorter times on dialysis compared with those with an AVF. Venous catheter or PD can be considered a viable bridge therapy in patients with living donor availability given their shorter waitlist times. Earlier referral of patients with living donor prospects might further minimize dialysis need.
Sections du résumé
Background
The optimal timing of dialysis access placement in individuals with stage 5 CKD is challenging to estimate. Preemptive living donor kidney transplant (LDKT) is the gold-standard treatment for ESKD due to superior graft survival and mortality, but dialysis initiation is often required. Among LDKT recipients, we sought to determine which clinical characteristics were associated with preemptive transplant. Among non-preemptive LDKT recipients, we sought to determine what dialysis access was used, and their duration of use before receipt of living donor transplant.
Methods
We retrospectively extracted data on 569 LDKT recipients, >18 years old, who were transplanted between January 2014 and July 2019 at UCSF, including dialysis access type (arteriovenous fistula [AVF], arteriovenous graft [AVG], peritoneal dialysis catheter [PD], and venous catheter), duration of dialysis, and clinical characteristics.
Results
Preemptive LDKT recipients constituted 30% of our cohort and were older, more likely to be White, more likely to have ESKD from polycystic kidney disease, and less likely to have ESKD from type 2 diabetes. Of the non-preemptive patients, 26% used AVF, 0.5% used AVG, 32% used peritoneal catheter, 11% used venous catheter, and 31% used more than one access type. Median (IQR) time on dialysis for AVF/AVG use was 1.86 (0.85-3.32) years; for PD catheters, 1.12 (0.55-1.92) years; for venous catheters, 0.66 (0.23-1.69) years; and for multimodal access, 2.15 (1.37-3.72) years.
Conclusions
We characterized the dialysis access landscape in LDKT recipients. Venous catheter and PD were the most popular modality in the first quartile of dialysis, and patients using these modalities had shorter times on dialysis compared with those with an AVF. Venous catheter or PD can be considered a viable bridge therapy in patients with living donor availability given their shorter waitlist times. Earlier referral of patients with living donor prospects might further minimize dialysis need.
Identifiants
pubmed: 35845334
doi: 10.34067/KID.0007652021
pii: 02200512-202206000-00017
pmc: PMC9255866
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1080-1088Informations de copyright
Copyright © 2022 by the American Society of Nephrology.
Déclaration de conflit d'intérêts
B.K. Lee reports serving on the American Society of Transplantation Living Donor Community of Practice Education Subcommittee. M. Park reports having consultancy agreements with Abalone Bio and Acelink Therapeutics; receiving honoraria from Grand Rounds and Healthcare Consultancy Group; having other interests in, or relationships with, Kadmon (as site principal investigator [PI] for a tesevatinib trial), Reata (site PI for A Trial of Bardoxolone Methyl in Patients with ADPKD - FALCON, and Sanofi (site PI for A Medical Research Study Designed to Determine if Venglustat Can be a Future Treatment for ADPKD Patients (STAGED-PKD) [now terminated]); having ownership interest in Merck (via spouse); and serving as an advisory board participant for Otsuka, Reata, and Sanofi. All remaining authors have nothing to disclose.
Références
Molnar MZ, Ojo AO, Bunnapradist S, Kovesdy CP, Kalantar-Zadeh K: Timing of dialysis initiation in transplant-naive and failed transplant patients. Nat Rev Nephrol 8: 284–292, 2012 10.1038/nrneph.2012.36
doi: 10.1038/nrneph.2012.36
Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE, Mehrotra R, Stevens PE, Wang AY, Cheung M, Wheeler DC, Winkelmayer WC, Pollock CA; Conference Participants: Dialysis initiation, modality choice, access, and prescription: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 96: 37–47, 2019 10.1016/j.kint.2019.01.017
doi: 10.1016/j.kint.2019.01.017
Meier-Kriesche HU, Kaplan B: Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis. Transplantation 74: 1377–1381, 2002 10.1097/00007890-200211270-00005
doi: 10.1097/00007890-200211270-00005
Becker BN, Rush SH, Dykstra DM, Becker YT, Port FK: Preemptive transplantation for patients with diabetes-related kidney disease. Arch Intern Med 166: 44–48, 2006 10.1001/archinte.166.1.44
doi: 10.1001/archinte.166.1.44
Mange KC, Joffe MM, Feldman HI: Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 344: 726–731, 2001 10.1056/NEJM200103083441004
doi: 10.1056/NEJM200103083441004
Goto N, Okada M, Yamamoto T, Tsujita M, Hiramitsu T, Narumi S, Katayama A, Kobayashi T, Uchida K, Watarai Y: Association of dialysis duration with outcomes after transplantation in a Japanese cohort. Clin J Am Soc Nephrol 11: 497–504, 2016 10.2215/CJN.08670815
doi: 10.2215/CJN.08670815
Prezelin-Reydit M, Combe C, Harambat J, Jacquelinet C, Merville P, Couzi L, Leffondré K: Prolonged dialysis duration is associated with graft failure and mortality after kidney transplantation: Results from the French transplant database. Nephrol Dial Transplant 34: 538–545, 2019 10.1093/ndt/gfy039
doi: 10.1093/ndt/gfy039
Lee H, Manns B, Taub K, Ghali WA, Dean S, Johnson D, Donaldson C: Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access. Am J Kidney Dis 40: 611–622, 2002 10.1053/ajkd.2002.34924
doi: 10.1053/ajkd.2002.34924
Helmick RA, Jay CL, Price BA, Dean PG, Stegall MD: Identifying barriers to preemptive kidney transplantation in a living donor transplant cohort. Transplant Direct 4: e356, 2018 10.1097/TXD.0000000000000773
doi: 10.1097/TXD.0000000000000773
United States Renal Data System: 2020 USRDS annual data report: Epidemiology of kidney disease in the United States, Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases, 2020
Woo K, Lok CE: New insights into dialysis vascular access: What is the optimal vascular access type and timing of access creation in CKD and dialysis patients? Clin J Am Soc Nephrol 11: 1487–1494, 2016 10.2215/CJN.02190216
doi: 10.2215/CJN.02190216
Schold JD, Sehgal AR, Srinivas TR, Poggio ED, Navaneethan SD, Kaplan B: Marked variation of the association of ESRD duration before and after wait listing on kidney transplant outcomes. Am J Transplant 10: 2008–2016, 2010 10.1111/j.1600-6143.2010.03213.x
doi: 10.1111/j.1600-6143.2010.03213.x
Voorzaat BM, van Schaik J, Siebelink HMJ, Tordoir JH, Rotmans JI: The pros and cons of preserving a functioning arteriovenous fistula after kidney transplantation. J Vasc Access 17 [Suppl 1]: S16–S22, 2016 10.5301/jva.5000525
doi: 10.5301/jva.5000525
Fraser CD 3rd, Grimm JC, Liu RH, Wesson RN, Azar F, Beaulieu RJ, Reifsnyder T: Removal of noninfected arteriovenous fistulae after kidney transplantation is a safe and beneficial management strategy for unused dialysis access. Ann Vasc Surg 53: 128–132, 2018 10.1016/j.avsg.2018.04.020
doi: 10.1016/j.avsg.2018.04.020
Andre M, Huang E, Everly M, Bunnapradist S: The UNOS Renal Transplant Registry: Review of the last decade. Clin Transpl 1–12, 2014
Kallab S, Bassil N, Esposito L, Cardeau-Desangles I, Rostaing L, Kamar N: Indications for and barriers to preemptive kidney transplantation: A review. Transplant Proc 42: 782–784, 2010 10.1016/j.transproceed.2010.02.031
doi: 10.1016/j.transproceed.2010.02.031
Innocenti GR, Wadei HM, Prieto M, Dean PG, Ramos EJ, Textor S, Khamash H, Larson TS, Cosio F, Kosberg K, Fix L, Bauer C, Stegall MD: Preemptive living donor kidney transplantation: Do the benefits extend to all recipients? Transplantation 83: 144–149, 2007
King KL, Husain SA, Jin Z, Brennan C, Mohan S: Trends in Disparities in Preemptive Kidney Transplantation in the United States. Clin J Am Soc Nephrol 14: 1500–1511, 2019 10.2215/CJN.03140319
doi: 10.2215/CJN.03140319
Gander JC, Zhang X, Plantinga L, Paul S, Basu M, Pastan SO, Gibney E, Hartmann E, Mulloy L, Zayas C, Patzer RE: Racial disparities in preemptive referral for kidney transplantation in Georgia. Clin Transplant 32: e13380, 2018 10.1111/ctr.13380
doi: 10.1111/ctr.13380
Jay CL, Dean PG, Helmick RA, Stegall MD: Reassessing preemptive kidney transplantation in the United States: Are we making progress? Transplantation 100: 1120–1127, 2016 10.1097/TP.0000000000000944
doi: 10.1097/TP.0000000000000944
Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL: Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: Differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet 388: 294–306, 2016 10.1016/S0140-6736(16)30448-2
doi: 10.1016/S0140-6736(16)30448-2
Bagdasarian N, Heung M, Malani PN: Infectious complications of dialysis access devices. Infect Dis Clin North Am 26: 127–141, 2012 10.1016/j.idc.2011.09.005
doi: 10.1016/j.idc.2011.09.005
United States Renal Data System: 2019 USRDS Annual Data Report: Epidemiology of kidney disease in the United States, Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases, 2019
Duque JC, Gomez C, Tabbara M, Alfonso CE, Li X, Vazquez-Padron RI, Asif A, Lenz O, Briones PL, Salman LH: The impact of arteriovenous fistulae on the myocardium: The impact of creation and ligation in the transplant era. Semin Dial 28: 305–310, 2015 10.1111/sdi.12313
doi: 10.1111/sdi.12313
Quarello F, Forneris G, Borca M, Pozzato M: Do central venous catheters have advantages over arteriovenous fistulas or grafts? J Nephrol 19: 265–279, 2006
Santoro D, Benedetto F, Mondello P, Pipitò N, Barillà D, Spinelli F, Ricciardi CA, Cernaro V, Buemi M: Vascular access for hemodialysis: Current perspectives. Int J Nephrol Renovasc Dis 7: 281–294, 2014 10.2147/IJNRD.S46643
doi: 10.2147/IJNRD.S46643
Adwaney A, Lim C, Blakey S, Duncan N, Ashby DR: Central venous stenosis, access outcome and survival in patients undergoing maintenance hemodialysis. Clin J Am Soc Nephrol 14: 378–384, 2019 10.2215/CJN.07010618
doi: 10.2215/CJN.07010618
Tedla FM, Clerger G, Distant D, Salifu M: Prevalence of central vein stenosis in patients referred for vein mapping. Clin J Am Soc Nephrol 13: 1063–1068, 2018 10.2215/CJN.14001217
doi: 10.2215/CJN.14001217
Shingarev R, Barker-Finkel J, Allon M: Natural history of tunneled dialysis catheters placed for hemodialysis initiation. J Vasc Interv Radiol 24: 1289–1294, 2013 10.1016/j.jvir.2013.05.034
doi: 10.1016/j.jvir.2013.05.034
Piraino B, Bernardini J, Brown E, Figueiredo A, Johnson DW, Lye WC, Price V, Ramalakshmi S, Szeto CC: ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit Dial Int 31: 614–630, 2011 10.3747/pdi.2011.00057
doi: 10.3747/pdi.2011.00057
De Lima JJ, Vieira ML, Molnar LJ, Medeiros CJ, Ianhez LE, Krieger EM: Cardiac effects of persistent hemodialysis arteriovenous access in recipients of renal allograft. Cardiology 92: 236–239, 1999 10.1159/000006980
doi: 10.1159/000006980
MacRae JM, Pandeya S, Humen DP, Krivitski N, Lindsay RM: Arteriovenous fistula-associated high-output cardiac failure: A review of mechanisms. Am J Kidney Dis 43: e17–e22, 2004 10.1053/j.ajkd.2004.01.016
doi: 10.1053/j.ajkd.2004.01.016
Abreo K, Sachdeva B, Abreo AP: To ligate or not to ligate hemodialysis arteriovenous fistulas in kidney transplant patients. J Vasc Access 22: 942–946, 2021 10.1177/1129729820970786
doi: 10.1177/1129729820970786
Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR): Available at: http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx Accessed, January 11, 2022