Dialysis after graft loss: a Swiss experience.

Bonani, Marco; Achermann, Rita; Seeger, Harald; Scharfe, Michael; Müller, Thomas; Schaub, Stefan; Binet, Isabelle; Huynh-Do, Uyen; Dahdal, Suzan; Golshayan, Dela; Hadaya, Karine; Wüthrich, Rudolf P; Fehr, Thomas; Segerer, Stephan (2020). Dialysis after graft loss: a Swiss experience. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 35(12), pp. 2182-2190. Oxford University Press 10.1093/ndt/gfaa037

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BACKGROUND

Patients returning to dialysis after graft loss have high early morbidity and mortality.

METHODS

We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded.

RESULTS

Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft.

CONCLUSION

In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension

UniBE Contributor:

Huynh-Do, Uyen and Dahdal, Suzan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1460-2385

Publisher:

Oxford University Press

Language:

English

Submitter:

Uyen Huynh-Do

Date Deposited:

05 May 2020 17:49

Last Modified:

15 Mar 2021 02:30

Publisher DOI:

10.1093/ndt/gfaa037

PubMed ID:

32170950

Uncontrolled Keywords:

allograft nephrectomy dialysis graft loss immunosuppression kidney transplantation

BORIS DOI:

10.7892/boris.143658

URI:

https://boris.unibe.ch/id/eprint/143658

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