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Dialysis after graft loss: a Swiss experience

Marco Bonani, Rita Achermann, Harald Seeger, Michael Scharfe, Thomas Müller, Stefan Schaub, Isabelle Binet, Uyen Huynh-Do, Suzan Dahdal, Déla Golshayan, Karine Hadaya, Rudolf P Wüthrich, Thomas Fehr & Stephan Segerer

abstract

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.
   
citation 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. Dialysis after graft loss: a Swiss experience. Nephrol Dial Transplant 2020; 35:2182-2190.
   
type journal paper/review (English)
date of publishing 04-12-2020
journal title Nephrol Dial Transplant (35/12)
ISSN electronic 1460-2385
pages 2182-2190
PubMed 32170950
DOI 10.1093/ndt/gfaa037