Longer pretransplant dialysis exposure is associated with a higher risk of transplant failure. Whether patients who receive dialysis in a region with a higher rate of dialysis mortality are a higher risk for transplant failure is unknown. Adjusted state-specific hemodialysis mortality rates were determined in 3-year intervals among prevalent dialysis patients in the United States between 1995 and 2012. The effect of state- and period-specific dialysis mortality on the association of pretransplant dialysis exposure with transplant survival through December 2017 was determined using multivariable models. Dialysis mortality within states ranged from 128 deaths/1000 patient-years to 330 deaths/1000 patient-years. Each additional year of dialysis was associated with a 4% higher risk of transplant failure in states within the lowest quartile of dialysis mortality, compared with an 8% higher risk in states within the highest quartile of dialysis mortality. Patients who received pretransplant dialysis treatment in a state with a high rate of dialysis mortality are at a higher risk for transplant failure compared with patients with the same duration of pretransplant dialysis treatment in a state with a lower mortality rate. The findings may have implications for dialysis care in transplant candidates and the design of future outcome metrics.
CITATION STYLE
Gill, J. S., Clark, S., Kadatz, M., & Gill, J. (2020). The association of pretransplant dialysis exposure with transplant failure is dependent on the state-specific rate of dialysis mortality. American Journal of Transplantation, 20(9), 2481–2490. https://doi.org/10.1111/ajt.15917
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