Introduction: In recent years in Japan, kidney transplantation has been recognized as the treatment of choice for end-stage renal failure; in particular, pre-emptive kidney transplantation (PEKT), which is performed without dialysis, has become more popular. Long-term dialysis syndrome, defined as complications from long-term dialysis such as cardiovascular disease, cerebrovascular disease, and infectious disease, is common. Therefore, kidney transplantation in long-term dialysis patients is often more difficult to manage than PEKT patients in terms of preventing the onset of perioperative complications or infectious disease. This study examined how dialysis length affects living-donor kidney transplantation outcomes.
Subjects and Methods: Subjects included 200 patients who underwent living-donor kidney transplantation at our hospital between January 2004 and December 2016. Subjects were classified into two groups: 182 with a dialysis history of < 10 years (short-term group) and 18 with a dialysis history ≥ 10 years (long-term group).
Results: The recipient and donor backgrounds differed significantly by recipient diabetes status, while no significant differences were observed in the other endpoints.  Despite the lack of a significant difference, the long-term dialysis group tended to have delayed graft function and a longer hospital stay. There was no significant difference in survival rate but there was a significant difference in graft survival rate. Four of 18 people (22.2%) in the long-term dialysis group died of intracranial hemorrhage, infectious disease, malignant tumor, and malignancy (n = 1 each). There were no significant differences in postoperative complications such as cytomegalovirus infection or rejection.
Discussion: This investigation showed that the kidney graft survival and postoperative complication rates of living-donor kidney transplantations for recipients in the long-term dialysis group performed in our department were not inferior to those in the short-term dialysis group. However, the long-term dialysis group had a worse patient survival rate than the short-term dialysis group. Japan has more than 320,000 dialysis patients, and the number of those on long-term dialysis has also been increasing. Japan also has the lowest organ donation rate among advanced countries; however, the mean waiting time for patients hoping for a kidney transplant exceeds 15 years. With the number of long-term dialysis patients increasing, we can expect the number of patients seeking transplantation after long-term dialysis to also continue growing. Although this study showed that kidney transplantation is no more problematic for long-term dialysis patients than short-term dialysis patients, long-term dialysis has already caused various complications for many patients, and attentive postoperative management and thorough outpatient follow-up are needed.