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Chronic kidney disease in stage V with renal replacement therapy may occur in the setting of any transplant (renal and nonrenal). Little is known about the prevalence of CKD and the survival of patients with nonrenal solid organ transplants in dialysis. Our objective is to determine the prevalence of patients with nonrenal transplantation with CKD V that are in dialysis, their clinical condition upon admission to dialysis and their survival rate.
Retrospective cohort. All incident adult patients (≥ 18 yeas) to dialysis in the period of 17 years (2005-2021), identified in the Argentine Dialysis and Transplant Registry, were included. In Argentina, it is mandatory the registration of incident patients on chronic renal replacement therapy and organ transplantation. This registration contains identification data, laboratory analyses, type of vascular access and patient´s comorbidities as well as the cause of ending renal replacement therapy (death). These variables are registered in an online form called DRI, which ensures data availability from all the country. The number and type of nonrenal solid organ transplantation done during this period were recorded, as well as the number of patients with nonrenal solid organ transplants who were admitted to dialysis (Tx No Renal). Patient's clinical status at the time of admission to dialysis of this subgroup was compared with the rest of the patients who entered dialysis during this period. We compared the survival rate of this subgroup of patients with patients in the transplant waiting list (Tx List) and with patients who had a contraindication for renal transplantation (Tx Contraindicated) who were on dialysis. Student's t-test, Wilcoxon test and Pearson Chi2 test were applied as appropriate. For survival analysis, the Kaplan Meier curves were constructed (log-rank test) and Cox proportional-hazards model adjusted for age, sex and presence of diabetes was applied. A p <0.05 was considered significant. The MedCalc statistical program was used.
In the analysed period, 108036 patients (59.7 ± 15 years old, female sex 40.9%) were admitted to dialysis, only 140 patients were carriers of Tx No Renal (57% Liver, 21% Cardiac, 12% Liver-Kidney, 7% Pancreas isolated, 4% Lung, 1% Bowel). Of the 7354 Tx No Renal performed over this period, only 1.9% were admitted to chronic dialysis. On admission to dialysis, patients with Tx No Renal were younger (54.8 ± 14 vs 60 ± 15 years); with a higher prevalence of male sex (68.5% vs 59%) and had a higher glomerular filtration rate. Patients who entered dialysis with a nonrenal transplant had a significantly lower mean survival time (34,4 month; 95%IC 24 to 44 month); comparing to 58 months and of 39 months for the subgroups of patients in Tx List and Tx Contraindicated respectively.
CKD stage V is an unusual complication in patients with nonrenal transplants. However, it represents a group of patients in dialysis that have high mortality. Organ distribution policies must consider this aspect in defining priorities for access to a kidney transplant