Renal transplantation in patients with polycystic kidney disease

A single-center experience

P. J. Tzardis, Rainer W G Gruessner, A. J. Matas, D. S. Fryd, W. D. Payne, D. L. Dunn, D. E R Sutherland, J. S. Najarian

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

During the 25-year period from 1963 to 1988, 127 patients with end-stage renal failure (ESRF) secondary to autosomal dominant polycystic kidney disease (ADPKD) received a total of 143 renal transplants. The average follow-up time was 116 months (range 3 to 300 months). Mean age (45.8 yr) was significantly higher than the average age in our transplant population (31 yr) (p < 0.001). No correlation was found between ADPKD and HLA-A or -B antigen frequency among the patients. Overall patient and graft survival was 90% and 73% at 1 yr, 74% and 53% at 5 yr, 55% and 36% at 10 yr, and 37% and 28% at 15 yr, respectively. When death with a functioning graft was excluded as a cause of graft loss, 15-yr graft survival was 57%. The most common causes of death were cardiovascular complications (46%) and infections (34%), while graft loss was mainly due to patient death (50%), or rejection (38%). Multivariable analysis showed patient survival to be influenced by the level of panel reacting antibodies at the time of transplantation (PRA) (p = 0.002), while graft survival was affected primarily by the donor status (living related vs. cadaver) (p = 0.02). Outcome in transplant patients with ADPKD was compared to outcome in two matched control groups: diabetic and nondiabetic transplant recipients. There was a lower patient survival rate for the diabetic group (p = 0.0003). Graft survival, however, was similar among the three groups, with the exception of diabetics treated with azathioprine, ALG and prednisone who appeared to have a lower graft survival rate (p = 0.0002). The cause of patient death and graft loss overall did not differ among the three groups studied; however, ADPKD and diabetic patients showed an increased death rate due to cardiovascular episodes for the time period between the 1st and 5th posttransplant years (p = 0.02). We conclude that, although ADPKD patients are older at the time of transplantation, they are excellent transplant candidates.

Original languageEnglish (US)
Pages (from-to)325-330
Number of pages6
JournalClinical Transplantation
Volume3
Issue number6
StatePublished - 1989
Externally publishedYes

Fingerprint

Polycystic Kidney Diseases
Kidney Transplantation
Autosomal Dominant Polycystic Kidney
Graft Survival
Transplants
Cause of Death
Survival Rate
Transplantation
HLA-A Antigens
Living Donors
Azathioprine
Prednisone
Cadaver
Chronic Kidney Failure
Research Design
Kidney
Antigens

Keywords

  • kidney
  • polycystic disease
  • transplantation

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

Tzardis, P. J., Gruessner, R. W. G., Matas, A. J., Fryd, D. S., Payne, W. D., Dunn, D. L., ... Najarian, J. S. (1989). Renal transplantation in patients with polycystic kidney disease: A single-center experience. Clinical Transplantation, 3(6), 325-330.

Renal transplantation in patients with polycystic kidney disease : A single-center experience. / Tzardis, P. J.; Gruessner, Rainer W G; Matas, A. J.; Fryd, D. S.; Payne, W. D.; Dunn, D. L.; Sutherland, D. E R; Najarian, J. S.

In: Clinical Transplantation, Vol. 3, No. 6, 1989, p. 325-330.

Research output: Contribution to journalArticle

Tzardis, PJ, Gruessner, RWG, Matas, AJ, Fryd, DS, Payne, WD, Dunn, DL, Sutherland, DER & Najarian, JS 1989, 'Renal transplantation in patients with polycystic kidney disease: A single-center experience', Clinical Transplantation, vol. 3, no. 6, pp. 325-330.
Tzardis, P. J. ; Gruessner, Rainer W G ; Matas, A. J. ; Fryd, D. S. ; Payne, W. D. ; Dunn, D. L. ; Sutherland, D. E R ; Najarian, J. S. / Renal transplantation in patients with polycystic kidney disease : A single-center experience. In: Clinical Transplantation. 1989 ; Vol. 3, No. 6. pp. 325-330.
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abstract = "During the 25-year period from 1963 to 1988, 127 patients with end-stage renal failure (ESRF) secondary to autosomal dominant polycystic kidney disease (ADPKD) received a total of 143 renal transplants. The average follow-up time was 116 months (range 3 to 300 months). Mean age (45.8 yr) was significantly higher than the average age in our transplant population (31 yr) (p < 0.001). No correlation was found between ADPKD and HLA-A or -B antigen frequency among the patients. Overall patient and graft survival was 90{\%} and 73{\%} at 1 yr, 74{\%} and 53{\%} at 5 yr, 55{\%} and 36{\%} at 10 yr, and 37{\%} and 28{\%} at 15 yr, respectively. When death with a functioning graft was excluded as a cause of graft loss, 15-yr graft survival was 57{\%}. The most common causes of death were cardiovascular complications (46{\%}) and infections (34{\%}), while graft loss was mainly due to patient death (50{\%}), or rejection (38{\%}). Multivariable analysis showed patient survival to be influenced by the level of panel reacting antibodies at the time of transplantation (PRA) (p = 0.002), while graft survival was affected primarily by the donor status (living related vs. cadaver) (p = 0.02). Outcome in transplant patients with ADPKD was compared to outcome in two matched control groups: diabetic and nondiabetic transplant recipients. There was a lower patient survival rate for the diabetic group (p = 0.0003). Graft survival, however, was similar among the three groups, with the exception of diabetics treated with azathioprine, ALG and prednisone who appeared to have a lower graft survival rate (p = 0.0002). The cause of patient death and graft loss overall did not differ among the three groups studied; however, ADPKD and diabetic patients showed an increased death rate due to cardiovascular episodes for the time period between the 1st and 5th posttransplant years (p = 0.02). We conclude that, although ADPKD patients are older at the time of transplantation, they are excellent transplant candidates.",
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