Kidney transplant prolongs life of patients on long-term dialysis

According to a recent study, a kidney transplant prolongs the lives of not only those patients, who have recently initiated dialysis, but also those who have been undergoing dialysis for more than a decade.

The findings indicate that patients, who may not have been referred for transplantation, should be re-evaluated.

John Gill, from the University of British Columbia and Vancouver's Providence Health Care, and his colleagues, examined whether patients, who receive transplants after a prolonged treatment with dialysis derive a similar survival benefit as those who undergo transplantation earlier.

"Because of the recent changes in the allocation policy, patients not previously wait-listed for many years can rapidly access transplantation if they are referred for it and accepted onto a waiting list," said Dr. Gill.

The researchers suspected that the benefit might not be the same because pre-transplant dialysis exposure is associated with inferior post-transplant kidney survival.

The team analysed 5,365 patients and determined the risk of death in recipients of a deceased donor kidney transplant after 10 or more years of dialysis treatment compared with wait-listed patients, who continued to undergo dialysis.

The patients were followed for at least five years.

The overall death rate for patients, who underwent transplantation was 3.9 per 100 patient-years, compared with 5.8 per 100 person-years for patients, who continued on dialysis.

After adjustments, the transplant recipients had a 40 per cent lower risk of dying than patients on dialysis, who had equal lengths of follow-up from their 10-year dialysis anniversary.

Transplant recipients were at a higher risk of death for 180 days after transplantation, however, and they did not derive survival benefit until 657 days after transplantation, despite receiving good quality kidneys.

The research appeared in the Clinical Journal of the American Society of Nephrology.