OJIM  Vol.4 No.3 , September 2014
Patients Returning to Dialysis after Failed Kidney Transplant: How Do They Fare? A Gulf Perspective
Abstract: An increasing number of failed transplant patients returning to dialysis (FTRD) have been observed with reported worse survival compared to transplant-naive dialysis (TxN) patients. This study aimed to assess outcomes of FTRD vs. matched TxN controls in a Gulf region multi-center trial of 800 HD patients. Similar mortality was seen, likely due to earlier start and better HD adequacy in FTRD. Younger age, less diabetes and living donor transplantation in majority with 27% graft nephrectomy (Nx) might also confer benefits. Subgroup analysis of Nx patients showed more hospitalizations and prior rejection episodes with lower graft survival. The deaths, however, oc-curred only in nonNx group and are likely explained by older age, longer duration on HD, more prevalence of diabetes and CAD. FTRD showed similar survival to TxN. Early intensive HD might account for the benefit. Whether Nx confers advantage is unclear because of the small sample size.
Cite this paper: Abouchacra, S. , Chaaban, A. , Saleh, A. , Rukhaimi, M. , Furaih, O. , Haq, N. , Osman, M. , Gebran, N. , Hussain, Q. , Chedid, F. , Budruddin, M. and Sajwani, S. (2014) Patients Returning to Dialysis after Failed Kidney Transplant: How Do They Fare? A Gulf Perspective. Open Journal of Internal Medicine, 4, 82-86. doi: 10.4236/ojim.2014.43013.

[1]   Perl, J., Bargman, J.M., Davies, S.J., et al. (2008) Clinical Outcomes after Failed Renal Transplantation-Does Dialysis Modality Matter? Seminars in Dialysis, 21, 239-244.

[2]   CORR Preliminary Report (2002) Preliminary Statistics for Renal Failure and Solid Organ Transplantation in Canada. Canadian Organ Replacement Register, Ottawa, 2193-2200.

[3]   Meier-Kriesche, H.U., Schold, J.D. and Kaplan, B. (2004) Long Term Allograft Survival: Have We Made Significant Progress or Is It Time to Rethink Our Analytic and Therapeutic Strategies? American Journal of Transplantation, 4, 1289-1295.

[4]   United States Renal Data System (2007) Chapter Seven. Transplantation.

[5]   Rockville, M.D., Richmond, V.A. and Ann Arbor, M.I. (2004) 2004 Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients.

[6]   Meier-Kriesche, H.U. and Kaplan, B. (2001) Death after Graft Loss: A Novel Endpoint for Renal Transplantation. Transplantation Proceedings, 33, 3405-3406.

[7]   Rao, P.S., Schaubel, D.E. and Saran, R. (2005) Impact of Graft Failure on Patient Survival on Dialysis: A Comparison of Transplant-Naive and Post-Graft Failure Mortality Rates. Nephrology Dialysis Transplantation, 20, 387-391.

[8]   Rao, P.S., Schaubel, D.E., Jia, X., et al. (2007) Survival on Dialysis Post-Kidney Transplant Failure: Results from the Scientific Registry of Transplant Recipients. American Journal of Kidney Diseases, 49, 294-300.

[9]   Fresnedo, G.F., Ruiz, J.C., Alamillo, C.G., et al. (2008) Survival after Dialysis Inititation: A Comparison of Transplant Patients after Graft Loss versus Nontransplant Patients. Transplantation Proceedings, 40, 2889-2890.

[10]   Sleiman, J., Garrigue, V., Vetromile, F., et al. (2007) Return to Dialysis after Renal Allograft Loss: Is Dialysis Treatment Initiated too Late? Transplantation Proceedings, 39, 2597-2598.

[11]   Akbari, A., Hussain, N., Karpinski, J., et al. (2007) Chronic Kidney Disease Management: Comparison between Renal Transplant Recipients and Nontransplant Patients with Chronic Kidney Disease. Nephron Clinical Practice, 107, c7-c13.

[12]   Gill, J.S., Abichandani, R., Kausz, A.T., et al. (2002) Mortality after Kidney Transplant Failure: The Impact of Non-Immunologic Factors. Kidney International, 62, 1875-1883.

[13]   Ansell, D., Udayaraj, U.P., Steenkamp, R., et al. (2007) Chronic Renal Failure in Kidney Transplant Recipients. Do They Receive Optimum Care? Data from the UK Renal Registry. American Journal of Transplantation, 7, 1167-1176.

[14]   Solid, C.A., Foley, R.N., Gill, J.S., et al. (2007) Epoetin Use and Kidney Disease Outcomes Quality Initiative Hemoglobin Targets in Patients Returning to Dialysis with Failed Renal Transplants. Kidney International, 71, 425-430.

[15]   Ayus, J.C., Achinger, S.G., Shuko, L., et al. (2010) Tranplant Nephrectomy Associates with Improved Survival in Patients with Failed Renal Allograft. Journal of the American Society of Nephrology, 21, 374-380.