Dialysis after graft loss: a Swiss experience.

Details

Serval ID
serval:BIB_F83ACDAFC155
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Dialysis after graft loss: a Swiss experience.
Journal
Nephrology, dialysis, transplantation
Author(s)
Bonani M., Achermann R., Seeger H., Scharfe M., Müller T., Schaub S., Binet I., Huynh-Do U., Dahdal S., Golshayan D., Hadaya K., Wüthrich R.P., Fehr T., Segerer S.
ISSN
1460-2385 (Electronic)
ISSN-L
0931-0509
Publication state
Published
Issued date
04/12/2020
Peer-reviewed
Oui
Volume
35
Number
12
Pages
2182-2190
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Patients returning to dialysis after graft loss have high early morbidity and mortality.
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.
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.
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.
Keywords
Adult, Female, Graft Rejection/epidemiology, Graft Rejection/etiology, Graft Rejection/mortality, Graft Rejection/therapy, Graft Survival, Humans, Immunosuppression, Kidney Failure, Chronic/pathology, Kidney Failure, Chronic/surgery, Kidney Transplantation/adverse effects, Kidney Transplantation/mortality, Male, Middle Aged, Nephrectomy/mortality, Prognosis, Renal Dialysis/mortality, Reoperation/mortality, Retrospective Studies, Risk Factors, Survival Rate, Switzerland/epidemiology, Transplantation, Homologous, allograft nephrectomy, dialysis, graft loss, immunosuppression, kidney transplantation
Pubmed
Web of science
Create date
02/04/2020 17:27
Last modification date
30/03/2021 6:34
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