Effect of Dialysis Modality on Transplantation Outcome in Living-Donor Renal Transplantation

Background: Peritoneal dialysis (PD) and Hemodialysis (HD) have been considered as two standard treatment methods in patients with end stage renal disease. It has been proposed that PD patients have a more protected volume status leading to a better renal transplantation outcome and lower incidence of post-transplant (DGF) delayed graft function , while HD exacerbates the immune disturbance by recurrent activation of inflammatory response, oxidative stress and free radical production that can contribute to DGF.

Objectives: In this retrospective study, we analyzed the effect of peritoneal dialysis (PD) or Hemodialysis (HD) on patients’ survival, graft survival, delayed graft function (DGF), acute rejection and early and late complication after living-donor renal transplantation.

Patients and methods: We retrospectively analyzed the data of patients who received their first living renal transplantation between December 2002 and Aril 2010. We entered only those patients who were on PD or HD for at least three months. We excluded patients who experienced DGF because of surgical complications. We allocated one or two aged and sex matched HD patients for one patient in PD group. All patients in each group were operated in a single transplant center.

Results: Of 143 patients who had their first living kidney transplant in, 69 patients (M/F 48/21 mean age: 35.3 ± 15.9 years) were in PD group and 74 patients (M/F 38/36 mean age: 40.7 ± 13.3 years) were in HD group. Mean age of donor in PD and HD group were 28.4 ± 4.4 and 29.7 ± 5.6 years. The number of diabetic patient in PD and HD groups were 11/69 (13.6%) and 16/74 (16.2%) (P: 0.4). The rate of delayed graft function, early acute rejection in PD and HD groups was as the followings: 3/69(4.3%) versus 3/74(4.1%) and 3/69(4.3%) versus 2/74 (2.7%). Comparison of overall five years patient and graft survival between the PD and HD patients showed no significant difference by log-rank test (P = 0.13 for patients survival), (P = 0.26 for grafts survival).

Conclusions: We found that the choice of dialysis modality does not influence the overall patient and graft survival and the rate of specific complications in living-donor renal transplantation.