Shimada H, Iwai T, Uchida J. Clinical impact of early graft function in kidney transplant recipients on long-term dialysis: A retrospective cohort study. World J Transplant 2025; 15(4): 108728 [DOI: 10.5500/wjt.v15.i4.108728]
Corresponding Author of This Article
Tomoaki Iwai, MD, PhD, Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan. iwai@omu.ac.jp
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Transplantation
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 18, 2025
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World Journal of Transplantation
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2220-3230
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Shimada H, Iwai T, Uchida J. Clinical impact of early graft function in kidney transplant recipients on long-term dialysis: A retrospective cohort study. World J Transplant 2025; 15(4): 108728 [DOI: 10.5500/wjt.v15.i4.108728]
World J Transplant. Dec 18, 2025; 15(4): 108728 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.108728
Clinical impact of early graft function in kidney transplant recipients on long-term dialysis: A retrospective cohort study
Hisao Shimada, Tomoaki Iwai, Junji Uchida
Hisao Shimada, Department of Urology, Asakayama General Hospital, Sakai 590-0018, Japan
Tomoaki Iwai, Junji Uchida, Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
Author contributions: Shimada H and Uchida J were responsible for the idea; Shimada H, Iwai T and Uchida J contributed to literature search, the intellectual content conception, write the manuscript, and prepared figures and tables.
Institutional review board statement: Approved for this study was obtained from the Ethics Committee of Graduate School of Medicine, Osaka Metropolitan University (No. 3604).
Informed consent statement: Patient consent was verified not by written informed consent but by opt-out consent, providing the patients with information on our research plan including the purpose, required individual data, and duration of research on our hospital website.
Conflict-of-interest statement: All the authors reported no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Data sharing statement: Data are available upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomoaki Iwai, MD, PhD, Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan. iwai@omu.ac.jp
Received: April 22, 2025 Revised: May 15, 2025 Accepted: August 25, 2025 Published online: December 18, 2025 Processing time: 210 Days and 23.4 Hours
Abstract
BACKGROUND
The impact of long-term dialysis (LTD) therapy on the survival benefit of kidney transplantation compared to short-term dialysis (STD) remains unclear. Additionally, donor organ quality has been identified as a significant predictor of patient survival in deceased donor kidney transplantation.
AIM
To investigate the effects of the best graft function within three months post-transplant, as well as dialysis duration, on transplant outcomes.
METHODS
A total of 255 patients were included in this retrospective cohort study. Patients were divided into two groups: Those with LTD (≥ 15 years; Group LTD) and those with STD (< 15 years; Group STD). Clinical backgrounds and outcomes were compared between the groups.
RESULTS
Group LTD comprised 28 patients, while Group STD included 227 patients. There were no significant differences between the two groups in terms of age at transplant, donor age, lowest serum creatinine (best S-Cr) within three months post-transplant, or the frequency of cardiovascular events after transplantation. Multivariate analysis identified age [hazard ratio (HR): 1.058; 95%CI: 1.002-1.116; P = 0.040], post-transplant incidence of cardiovascular disease (HR: 20.264; 95%CI: 6.052-67.850; P < 0.001), and best S-Cr (HR: 4.155; 95%CI: 2.234-7.730; P < 0.001) as independent predictors of mortality after transplantation. The pre-operative dialysis period was not statistically significant.
CONCLUSION
These findings suggest that early graft dysfunction, rather than dialysis duration, may serve as a critical risk factor for poor transplant outcomes.
Core Tip: This retrospective cohort study investigated the impact of dialysis duration and early graft function on kidney transplant outcomes. Among 255 recipients, no significant differences were found between long- and short-term dialysis groups in key clinical variables. Multivariate analysis identified age, post-transplant cardiovascular events, and best serum creatinine within three months as independent predictors of mortality. In contrast, dialysis duration was not associated with post-transplant survival. These findings highlight that early graft function may be more critical than dialysis duration in determining long-term transplant outcomes.
