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Patients restarting dialysis after failed renal transplant


, : Patients restarting dialysis after failed renal transplant. Schweizerische Medizinische Wochenschrift 122(39): 1452-1457

Numerous reports have dealt with patient survival and prognostic factors after renal replacement therapy. However, few data exist for patients after a failed renal transplant and who start dialysis again. With this purpose, we retrospectively studied 36 patients who returned to dialysis after a mean transplantation time of 42.8 +- 7.8 months. Actuarial patient survival on dialysis after the failed renal transplant (D2) was 78%, 74%, 69% and 41% at 1, 2 , 3 and 5 years after restarting dialysis respectively. In comparison, survival of patients who started dialysis without a previous history of a renal transplant showed rates of 91%, 85%, 79% and 64% at 1,2,3 and 5 years respectively. The difference was statistically significant only at one year after beginning dialysis therapy (78% vs. 91%, p lt 0.025). There were no differences in plasma urea concentration by the time of starting both first (D1) and second (D2) dialysis treatments (37.4 +- 1.9 and 38.8 +- 2.9 mmol/L respectively). Instead, a statistically significant difference was found between corresponding serum creating values (1100.1 +- 47.1 and 856.9 +- 50.0 mu-mol/L respectively, p lt 0.05). When actuarial survival and serum creatinine values at the start of D2 were analyzed, there was a statistically better survival at 1 year for patients with serum creatinine values under 900 mu-mol/L, as compared with those above 900 mu-mol/L (85% vs. 52%, p lt 0.05). Analysis by multivariate methods of the influence of clinical parameters on patient survival, both during the transplantation period and immediately before D2, failed to reveal any association with a better prognosis, except for a higher mean age in the group with poorer survival (46.3 +- 4.0 vs. 34.5 +- 2.7 years, p lt 0.02). The data show that survival on dialysis is lower after a failed renal transplant when compared with patients starting dialysis for the first time. They also suggest that an early end to immunosuppressive treatment after the patients return to dialysis would be advantageous.

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