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Outcomes and Allograft Survival of Patients Who Underwent a Second Kidney Transplant and Were Followed Up for 10 Years. Transplant Proc 2022; 54:1228-1235. [DOI: 10.1016/j.transproceed.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 11/23/2022]
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Kainz A, Kammer M, Reindl-Schwaighofer R, Strohmaier S, Petr V, Viklicky O, Abramowicz D, Naik M, Mayer G, Oberbauer R. Waiting Time for Second Kidney Transplantation and Mortality. Clin J Am Soc Nephrol 2022; 17:90-97. [PMID: 34965955 PMCID: PMC8763155 DOI: 10.2215/cjn.07620621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The median kidney transplant half-life is 10-15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980-2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies "retransplant" versus "remain waitlisted with maintenance dialysis" are reported for different waiting times after first graft loss. RESULTS Second kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, -14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively. CONCLUSIONS Second kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.
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Affiliation(s)
- Alexander Kainz
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Michael Kammer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria,Institute of Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Susanne Strohmaier
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Vojtěch Petr
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ondrej Viklicky
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | - Marcel Naik
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin, Berlin, Germany,Berlin Institute of Health, Berlin, Germany
| | - Gert Mayer
- Department of Internal Medicine IV–Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria,Austrian Dialysis and Transplant Registry, Innsbruck, Austria
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
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Girerd S, Girerd N, Duarte K, Giral M, Legendre C, Mourad G, Garrigue V, Morelon E, Buron F, Kamar N, Del Bello A, Ladrière M, Kessler M, Frimat L. Preemptive second kidney transplantation is associated with better graft survival compared with non-preemptive second transplantation: a multicenter French 2000-2014 cohort study. Transpl Int 2017; 31:408-423. [PMID: 29210106 DOI: 10.1111/tri.13105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/07/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
The impact of preemptive second kidney transplantation (2KT) on graft and patient survival is poorly established. The association between preemptive 2KT (p2KT, N = 93) and outcomes was estimated in a multicenter French cohort of 2KT (N = 1314) recipients using propensity score methods. During the follow-up, there were 274 returns to dialysis and 134 deaths. p2KT was associated with lower death-censored graft loss (HR = 0.39 [0.18-0.88], P = 0.024) and graft failure from any cause including death (HR = 0.42 [0.22-0.80], P = 0.008). Similar associations were observed for death with a functioning graft, although not reaching statistical significance (HR = 0.47 [0.17-1.26], P = 0.13). There was a significant interaction between donor type and p2KT (P for interaction = 0.016). Indeed, p2KT was not significantly associated with the risk of graft failure from any cause including death in living donor 2KT (P = 0.39), whereas the association was substantial in the deceased donor subset (HR = 0.30 [0.14-0.64], P = 0.002). Of note, the adjusted graft survival of p2KT with deceased donor paralleled that of 2KT with living donor, either preemptive or not (93.8% vs. 88.6% at 4 years and 76.1% vs. 70.5% at 8 years, P = 0.13). This large French multicenter study analyzed using propensity scores suggests that p2KT is associated with better graft prognosis.
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Affiliation(s)
- Sophie Girerd
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France.,INSERM, Clinical Investigation Center 1433, Lorraine University, F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- INSERM, Clinical Investigation Center 1433, Lorraine University, F-CRIN INI-CRCT, Nancy, France
| | - Kevin Duarte
- INSERM, Clinical Investigation Center 1433, Lorraine University, F-CRIN INI-CRCT, Nancy, France
| | - Magali Giral
- Department of Nephrology and Kidney Transplantation, University Hospital of Nantes, Nantes, France
| | - Christophe Legendre
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Georges Mourad
- Department of Nephrology and Kidney Transplantation, University Hospital of Montpellier, Montpellier, France
| | - Valérie Garrigue
- Department of Nephrology and Kidney Transplantation, University Hospital of Montpellier, Montpellier, France
| | - Emmanuel Morelon
- Department of Nephrology and Kidney Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fanny Buron
- Department of Nephrology and Kidney Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Rangueil Hospital, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Rangueil Hospital, Toulouse, France
| | - Marc Ladrière
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Michèle Kessler
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Luc Frimat
- Department of Nephrology and Kidney Transplantation, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
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