To investigate the impact of different preoperative dialysis modalities and durations on the prognosis of renal transplantation.

The clinical data of 451 recipients who underwent allogeneic renal transplantation at the Remin Hospital of Wuhan University from January 2015 to June 2019, and received dialysis before operation and were followed up regularly after operation were analyzed retrospectively. According to different preoperative dialysis methods, 451 recipients were divided into hemodialysis (HD) group (n=365) and peritoneal dialysis (PD) group (n=86). According to different preoperative dialysis duration, recipients were also divided into dialysis duration ≤1 year group (n=214), dialysis duration >1-<3 years group (n=118), and dialysis duration ≥3 years group (n=119). The follow-up deadline was June 30, 2022. The serum creatinine level, the incidence rate of complications and the survival rate of recipients/transplanted kidneys within 3 years after renal transplantation were compared between the two groups. Measurement data were compared by group t-test or Mann-Whitney U test, enumeration data were compared by χ² test. Survival curves were plotted using the Kaplan-Meier method and recipient/graft survival was compared using the log-rank test. P<0.05 was considered statistically significant.

There were no statistical differences in age, sex, body mass index, length of preoperative dialysis, preoperative complications and primary disease between the PD group and HD group (P>0.05). Renal allograft function recovered well in both groups, there was no statistical difference in serum creatinine level at different time after operation (P>0.05). There were no statistical differences in incidence of delayed graft function (DGF), pulmonary infection, acute rejection (AR), renal allograft vascular complications, cardiovascular disease (CVD) and urinary system complications after operation between the two groups (P>0.05). There were significant differences in the incidence of DGF and AR among the three groups of recipients with preoperative dialysis duration ≤1 year, >1-<3 years and ≥3 years. The incidence of DGF and AR in the group with dialysis duration ≥3 years was higher than that in the group with dialysis duration ≤1 year (χ²=7.13 and 13.962, P<0.0167). The survival rates of recipients at 3 years after operation in the PD group and HD group were 94.2% and 95.3%, respectively, and the survival rates of transplanted kidneys were 91.9% and 91.0%, respectively, and the differences were not statistically significant (χ²=0.029 and 0.112, P>0.05). The 3-year survival rates of recipients in the three groups with preoperative dialysis duration ≤1 year, >1-<3 years and ≥3 years were 96.3%, 94.9% and 93.3%, respectively, and the renal allograft survival rates were 93.0%, 89.8% and 89.1%, respectively, and the differences were not statistically significant (χ²=1.483 and 1.785, P>0.05).

Different dialysis methods before renal transplantation have no significant effect on the recovery of renal allograft function, complications, and recipient/renal allograft survival rate, but the prolonged duration of preoperative dialysis will lead to an increase in the incidence of DGF and AR.