ArticlePloS one2026
Pre-transplant dialysis vintage and post-transplant outcomes: A retrospective cohort study in Korean kidney transplant recipients.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundKidney transplantation (KT) is the preferred treatment for end-stage renal disease (ESRD) due to its advantages over dialysis. Although the benefits of preemptive KT are well established, the association between pre-transplant dialysis duration and post-transplant outcomes remains uncertain.
objectiveTo evaluate the association between pre-transplant dialysis vintage and post-transplant outcomes in Korean KT recipients using real-world data from a tertiary transplant center.
methodsWe retrospectively evaluated 1,843 first KT recipients transplanted between 2006-2021. Dialysis duration was used as a categorical variable divided by tertiles according to distribution of time of analysis, and preemptive transplantation was categorized as a separate group. Primary outcomes included death-censored graft loss, all-cause mortality and composite outcomes. Survival was assessed using Kaplan-Meier and Cox proportional hazards models at a 95% confidence level. A deceased-donor KT (DDKT) subgroup analysis was also performed.
results369 patients underwent preemptive KT, and 1,474 dialysis-exposed recipients were categorized into tertile 1 (n = 492), tertile 2 (n = 491), and tertile 3 (n = 491), with mean pre-transplant dialysis durations of 1.2, 21.4, and 107.6 months, respectively. Compared with preemptive KT, all-cause mortality did not differ in the first or second tertiles but was significantly higher in the third tertile (aHR 3.55; 95% CI 1.43-8.81; p = 0.006). In the overall cohort, the third tertile was also associated with higher risks of death-censored graft failure and the composite outcome. However, in the deceased-donor KT subgroup, death-censored graft failure did not differ significantly across tertiles, and the composite outcome did not show a monotonic dose-response pattern.
conclusionsProlonged pre-transplant dialysis was associated with a higher risk of all-cause mortality, whereas its association with graft failure was less consistent, particularly among deceased-donor KT recipients.
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