Renal Transplant for Patients on Long-term dialysis (20 or more years) at our Center

Background: In Japan, patients undergoing dialysis (HD) are increasing every year, and the number has reached 329,609 at the end of 2016. Out of them, 26,313 patients were undergoing longterm HD (LHD; 20 or more years), which is 8.3% of the total number. The number of renal transplantation (RTx) was 1,648 in 2016, 1,471 for living donor RTx (LRTx) and 177 for deceased donor RTx (DRTx). Moreover, in Japan, DRTx did not increase, while the number of patients enrolled in the waiting list for DRTx reached approximately 13,000. Due to this discrepancy, the mean waiting period of DRTx is approximately 17 years, and many patients waiting for DRTx have no choice but to choose LRTx. LHD patients are at a risk of serious morbidity and mortality from the various complications of HD, which hamper outcomes of RTx. Patients and methods: This study was designed to investigate the results of RTx in LHD patients. Ninety patients underwent RTx between May 2006 and December 2017, of which 14 patients were in the LHD group. The most important surgical problem in RTx of the patients on LHD is a contracted disuse bladder (CDB). Its incidence was 42.9% (6 out of 14 patients) in LHD group and 5.3% (4 out of 76 patients) in non-LHD group respectively, significantly higher in non-LHD group than in non-LHD group(p=0.02). Results: All of patients with a CDB underwent ureteroureterostomy. Patients on LHD showed significantly lower graft survival and patient survival rate than those on non-LHD (LHD: 8/14, 57.1% vs. non-LHD: 62/76, 81.6%, p=0.02 and LHD: 12/14, 85.7% vs. non- LHD: 73/76, 96.1%, p=0.004). Conclusion: Preoperative evaluation and perioperative countermeasures are required in LHD patients.