Long-Term Outcomes and Prognostic Factors in Kidney Transplant Recipients with Polycystic Kidney Disease

Gauri Bhutani, Brad C. Astor, Didier A. Mandelbrot, Lori Mankowski-Gettle, Timothy Ziemlewicz, Shane A. Wells, Leah Frater-Rubsam, Vanessa Horner, Courtney Boyer, Jennifer Laffin, Arjang Djamali

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background Polycystic kidney disease (PKD) accounts for approximately 15% of kidney transplants, but long-term outcomes in patients with PKD who have received a kidney transplant are not well understood. Methods In primary recipients of kidney transplants at our center (1994-2014), we compared outcomes of underlying PKD (N619) with other native diseases (non-PKD, N4312). Potential factors influencing outcomes in PKD were evaluated using Cox proportional-hazards regression and a rigorous multivariable model. Results Patients with PKD were older and were less likely to be sensitized or to experience delayed graft function (DGF). Over a median follow-up of 5.6 years, 1256 of all recipients experienced death-censored graft failure (DCGF; 115 patients with PKD) and 1617 died (154 patients with PKD). After adjustment for demographic, dialysis, comorbid disease, surgical, and immunologic variables, patients with PKD had a lower risk of DCGF (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.57 to 0.93; P0.01) and death (aHR, 0.62; 95% CI, 0.51 to 0.75; P<0.001). In our multiadjusted model, calcineurin-inhibitor (CNI) use was associated with lower risk of DCGF (aHR, 0.45; 95% CI, 0.26 to 0.76; P0.003), whereas HLA mismatch of five to six antigens (aHR, 2.1; 95% CI, 1.2 to 3.64; P0.009) was associated with higher likelihood of DCGF. Notably, both pretransplant coronary artery disease (CAD) and higher BMI were associated with increased risk of death (CAD, aHR, 2.5; 95% CI, 1.69 to 3.71; P<0.001; per 1 kg/m 2 higher BMI, aHR, 1.07; 95% CI, 1.04 to 1.11; P<0.001), DCGF, and acute rejection. Nephrectomy at time of transplant and polycystic liver disease were not associated with DCGF/death. Incidence of post-transplant diabetes mellitus was similar between PKD and non-PKD cohorts. Conclusions Recipients with PKD have better long-term graft and patient survival than those with non-PKD. Standard practices of CNI use and promoting HLA match are beneficial in PKD and should continue to be promoted. Further prospective studies investigating the potential benefits of CNI use and medical/surgical interventions to address CAD and the immunologic challenges of obesity are needed. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2021_02_25_KID0001182019.mp3

Original languageEnglish (US)
Pages (from-to)312-324
Number of pages13
JournalKidney360
Volume2
Issue number2
DOIs
StatePublished - Feb 1 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2021 by the American Society of Nephrology.

Keywords

  • calcineurin inhibitor
  • coronary artery disease
  • death
  • graft survival
  • human leukocyte antigen (HLA)
  • kidney transplant
  • nephrectomy
  • obesity
  • polycystic kidney disease
  • post-transplant diabetes mellitus
  • transplantation

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