#2573 Effect of pre-transplant dialysis modalities on delayed graft function

Abstract Background and Aims Kidney transplantation represents the optimal treatment for end-stage renal disease patients. Benefits and disadvantages of different pre-transplant dialysis modalities and the effects on post-transplant outcomes remain unclear, but many authors identify peritoneal dialysis (PD) such a “bridge” versus renal transplantation. Method We analyze a consecutive series of 249 renal transplanted patients (mean age 48 ± 11 years, 67% males) between June 1998 and February 2016 with a low prevalence of comorbidities (diabetes 2%, hypertension 31%, previous cardiovascular events 2%). The median follow-up was 136 months interquartile range (IR) 91-197 months. The pre-transplant treatment was hemodialysis (HD) in 215 patients (86%) and peritoneal dialysis (PD) in the remaining 34 patients (14%). The majority of patients received a cadaveric donor organ (219 patients, 88%). Results Delayed Graft Function (DGF) was registered in 151 patients (61%). Analyzing pre-transplant dialysis treatment, 15 patients about 34 (44%) on pre-transplant PD had DGF vs 136/215 (63%) on pre-transplant HD treatment (P = 0.03). Remarkable PD patients were older (48 ± 12 years) than HD patients (44 ± 11 years), but this difference did not rise statistical significance (P = 0.09); similarly the prevalence of living donors were higher (13%) in the group of HD patients respect the group of PD patients (9%, P = 0.53). In a longitudinal analysis the last estimated Glomerular Filtration Rate (eGFR) was lower in patients with DGF (44, IR 19-66 ml/min/1,73 m2) vs patients without DGF (48, IR 35-73 ml/min/1,73 m2, P = 0.04), but no substantial differences was noted at the end of observation in eGFR between the two groups of patients (HD, eGFR 45, IR 25-68 ml/min/1,73 m2 vs PD eGFR 46, IR 24-67 ml/min/1,73 m2). Conclusion Results of this study confirm that PD treatment can be considered an optimal “bridge” for renal transplantation probably because peculiar characteristic of this dialysis modality (such us long term preserved diuresis and residual renal function respect HD patients) impacts positively on recovery of renal function. Further study need to clarify these controversial points.