Clinical impact of early graft function in kidney transplant recipients on long-term dialysis: A retrospective cohort study.

BACKGROUND: The impact of long-term dialysis (LTD) therapy on the survival benefit of kidney transplantation compared to short-term dialysis (STD) remains unclear. Additionally, donor organ quality has been identified as a significant predictor of patient survival in deceased donor kidney transplantation. AIM: To investigate the effects of the best graft function within three months post-transplant, as well as dialysis duration, on transplant outcomes. METHODS: A total of 255 patients were included in this retrospective cohort study. Patients were divided into two groups: Those with LTD (≥ 15 years; Group LTD) and those with STD (< 15 years; Group STD). Clinical backgrounds and outcomes were compared between the groups. RESULTS: Group LTD comprised 28 patients, while Group STD included 227 patients. There were no significant differences between the two groups in terms of age at transplant, donor age, lowest serum creatinine (best S-Cr) within three months post-transplant, or the frequency of cardiovascular events after transplantation. Multivariate analysis identified age [hazard ratio (HR): 1.058; 95%CI: 1.002-1.116; P = 0.040], post-transplant incidence of cardiovascular disease (HR: 20.264; 95%CI: 6.052-67.850; P < 0.001), and best S-Cr (HR: 4.155; 95%CI: 2.234-7.730; P < 0.001) as independent predictors of mortality after transplantation. The pre-operative dialysis period was not statistically significant. CONCLUSION: These findings suggest that early graft dysfunction, rather than dialysis duration, may serve as a critical risk factor for poor transplant outcomes.