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Abstract
The waiting time for deceased donor kidney transplants (DDKT) is increasing. We evaluated DDKT prognosis according to the pretransplant dialysis vintage. A total of 4117 first-time kidney transplant recipients were enrolled from a prospective nationwide cohort in Korea. DDKT recipients were divided into tertiles according to pretransplant dialysis duration. Graft failure, mortality, and composite were compared between DDKT and living donor kidney transplant (LDKT) recipients. Pretransplant dialysis vintage was longer annually in DDKT recipients. In the subdistribution of the hazard model for the competing risk, the first tertile did not show an increased risk of graft failure compared with LDKT recipients; however, the second and third tertile groups had an increased risk of graft failure compared to LDKT recipients (adjusted hazard ratio [aHR] 3.59; 95% confidence interval [CI] 1.69–7.63; P < 0.001; aHR 2.37; 95% CI 1.06–5.33; P = 0.037). All DDKT groups showed a significantly higher risk of patient death than LDKT, with the highest risk in the third tertile group (aHR 11.12; 95% CI 4.94–25.00; P < 0.001). A longer pretransplant dialysis period was associated with a higher risk of the composite of patient death and graft failure in DDKT recipients. DDKT after a short period of dialysis had non-inferior results on graft survival compared with LDKT.
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1 Kyungpook National University, Kyungpook National University Hospital, Department of Internal Medicine, School of Medicine, Daegu, South Korea (GRID:grid.411235.0) (ISNI:0000 0004 0647 192X)
2 Kyungpook National University, Department of Statistics, Daegu, South Korea (GRID:grid.258803.4) (ISNI:0000 0001 0661 1556)
3 Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Department of Surgery, Wonju, South Korea (GRID:grid.464718.8) (ISNI:0000 0004 0647 3124)
4 Inje University Busan Paik Hospital, Department of Internal Medicine, Busan, South Korea (GRID:grid.411625.5) (ISNI:0000 0004 0647 1102)
5 Bongseng Memorial Hospital, Department of Internal Medicine, Busan, South Korea (GRID:grid.414550.1) (ISNI:0000 0004 0647 985X)
6 Yonsei University College of Medicine, Department of Internal Medicine, Seoul, South Korea (GRID:grid.15444.30) (ISNI:0000 0004 0470 5454)
7 Yonsei University College of Medicine, Department of Surgery, Seoul, South Korea (GRID:grid.15444.30) (ISNI:0000 0004 0470 5454)
8 BHS Hanseo Hospital, Department of Nephrology, Pusan, Republic of Korea (GRID:grid.15444.30)
9 Han Yang University, Department of Surgery, College of Medicine, Seoul, Republic of Korea (GRID:grid.15444.30)
10 Korea University Anam Hospital, Department of Surgery, Seoul, Republic of Korea (GRID:grid.411134.2) (ISNI:0000 0004 0474 0479)
11 Bucheon St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Bucheon, Republic of Korea (GRID:grid.414678.8) (ISNI:0000 0004 0604 7838)
12 Jeonbuk National University Hospital, Department of Internal Medicine, Jeonju, Republic of Korea (GRID:grid.411545.0) (ISNI:0000 0004 0470 4320)
13 Gachon University College of Medicine, Department of Surgery, Gil Medical Center, Incheon, Republic of Korea (GRID:grid.256155.0) (ISNI:0000 0004 0647 2973)
14 Sungkyunkwan University School of Medicine, Department of Surgery, Samsung Medical Center, Suwon, Republic of Korea (GRID:grid.264381.a) (ISNI:0000 0001 2181 989X)
15 Konkuk University School of Medicine, Department of Nephrology, Seoul, Republic of Korea (GRID:grid.258676.8) (ISNI:0000 0004 0532 8339)
16 Yeungnam University Hospital, Department of Nephrology, Daegu, Republic of Korea (GRID:grid.413040.2) (ISNI:0000 0004 0570 1914)
17 Eunpyeong St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.414966.8) (ISNI:0000 0004 0647 5752)
18 Pusan National University Hospital, Department of Internal Medicine, Pusan, Republic of Korea (GRID:grid.412588.2) (ISNI:0000 0000 8611 7824)
19 Ewha Womans University Seoul Hospital, Department of Surgery, Seoul, Republic of Korea (GRID:grid.255649.9) (ISNI:0000 0001 2171 7754)
20 Kosin University College of Medicine, Department of Internal Medicine, Division of Nephrology, Pusan, Republic of Korea (GRID:grid.411144.5) (ISNI:0000 0004 0532 9454)
21 Seoul St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.414966.8) (ISNI:0000 0004 0647 5752)
22 The Catholic University of Korea College of Medicine, Department of Internal Medicine, College of Medicine, Incheon St. Mary’s Hospital, Bucheon, Republic of Korea (GRID:grid.411947.e) (ISNI:0000 0004 0470 4224)
23 Chungnam National University Hospital, Department of Nephrology, Daejeon, Republic of Korea (GRID:grid.411665.1) (ISNI:0000 0004 0647 2279)
24 Kyung Hee University Hospital at Gangdong, Department of Nephrology, Seoul, Republic of Korea (GRID:grid.496794.1)
25 Ajou University School of Medicine, Department of Surgery, Suwon, Republic of Korea (GRID:grid.251916.8) (ISNI:0000 0004 0532 3933)
26 CHA University, Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea (GRID:grid.410886.3) (ISNI:0000 0004 0647 3511)
27 SMG-SNU Boramae Medical Center, Department of Nephrology, Seoul, Republic of Korea (GRID:grid.412479.d)
28 Myongji Hospital, Department of Surgery, Goyang, Republic of Korea (GRID:grid.416355.0) (ISNI:0000 0004 0475 0976)
29 Soonchunhyang University Seoul Hospital, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.412678.e) (ISNI:0000 0004 0634 1623)
30 Inje University Ilsan Paik Hospital, Department of Surgery, Goyang, Republic of Korea (GRID:grid.411633.2) (ISNI:0000 0004 0371 8173)
31 Kyung Hee University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.289247.2) (ISNI:0000 0001 2171 7818)
32 Ewha Womans University Mokdong Hospital, Department of Surgery, Seoul, Republic of Korea (GRID:grid.411076.5)
33 Ulsan University Hospital, Department of Internal Medicine, Ulsan, Republic of Korea (GRID:grid.412830.c) (ISNI:0000 0004 0647 7248)
34 Seoul National University Bundang Hospital, Division of Nephrology, Seoul, Republic of Korea (GRID:grid.412480.b) (ISNI:0000 0004 0647 3378)
35 Chonnam National University Medical School, Department of Surgery, Gwangju, Republic of Korea (GRID:grid.14005.30) (ISNI:0000 0001 0356 9399)
36 Asan Medical Center, Department of Surgery, Seoul, Republic of Korea (GRID:grid.413967.e) (ISNI:0000 0001 0842 2126)
37 Keimyung University School of Medicine, Department of Internal Medicine, Daegu, Republic of Korea (GRID:grid.412091.f) (ISNI:0000 0001 0669 3109)