Short dialysis before transplant linked to 91.8% 10-year graft survival

Eight hundred and five adults in Japan received a living-donor kidney transplant, and the timing of dialysis before that operation separated their long-term outcomes. In the cohort studied by Keisuke Maeda and colleagues at Hokkaido University Hospital in Sapporo, patients who had undergone less than two years of pretransplant dialysis recorded 91.8% graft survival at 10 years.

That figure fell to 82.0% among recipients who had been on dialysis for two years or more. A graft, or allograft, is the transplanted kidney and its continued survival is a central measure of whether the procedure has held up over time. The study covered living-donor transplants performed between 2001 and 2021.

The researchers also compared nonpreemptive transplantation—performed after dialysis has started—with preemptive transplantation, performed before dialysis. The nonpreemptive group had lower allograft survival, with a hazard ratio of 1.67, a measure indicating higher relative risk in the comparison. When the analysis accounted for several factors, two or more years of dialysis was associated with a hazard ratio of 2.61 for graft loss; male recipient status and diabetic nephropathy were also suggested risk factors, at 2.35 and 2.94.

And so, concretely? For a patient nearing a planned kidney transplant, the results support starting dialysis when it is medically needed rather than postponing it simply to preserve the future graft. That does not make dialysis risk-free, and it does not turn a population result into an individual prescription; the study shows an association in a Japanese cohort, not proof that dialysis duration alone caused every difference.

The authors’ conclusion is narrower and useful: dialysis started not long before kidney transplantation did not seem to lower allograft survival. The findings appeared online in the International Journal of Urology.