Scimago Lab
powered by Scopus
call: +1.631.629.4327
Mon-Fri 10 am - 2 pm EST


Medical Science Monitor Basic Research


eISSN: 2329-0358

Get your full text copy in PDF

Risk Factors Influencing the Outcomes of Kidney Re-Transplantation

Anke Schwarz, Frank Schäfer, Theodor Framke, Silvia Linnenweber-Held, Nicolas Richter, Hermann Haller

(Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany)

Ann Transplant 2021; 26:e928922

DOI: 10.12659/AOT.928922

BACKGROUND: Our kidney transplant waitlist includes 20% re-transplantations (TX2). Knowing what to expect is a clinical obligation.
MATERIAL AND METHODS: We compared graft and patient survival of all 162 TX2 patients, transplanted 2000 to 2009, with 162 patients after first transplantation (TX1) matched for age, sex, living/non-living donation, and transplantation date. Patient follow-up was 10 years.
RESULTS: TX2 graft and patient survivals were inferior to TX1 (p<0.001 and p=0.047). TX2 patients had a longer cumulative dialysis vintage, more human leucocyte antigen (HLA) mismatches, more panel-reactive HLA antibodies, more often received induction therapy with rabbit-antithymocyte globulin (rATG), and had a lower body mass index (all p<0.05). Death from infection and graft failure by rejection was more frequent after TX2 (both p<0.05) but not after TX1. Multivariable Cox regression analysis revealed that both cohorts had graft failure and death risk associated with infection and cardiovascular disease, and graft failure by humoral rejection. However, only TX2 patients had an additional risk of graft failure with early inferior graft function and of patient death with ≥2 comorbidities. Moreover, Kaplan-Meier analysis showed that TX2 and not TX1 patients had a lower graft and patient survival associated with infection and with ≥2 comorbidities (all p<0.05).
CONCLUSIONS: Re-transplantation is associated with worse graft outcomes mainly because of immunologic and graft-quality reasons, although the high number of comorbidities and infection severities aside from cardiovascular disease drive mortality. The more frequent rATG induction of TX2 patients could promote infection by enhancing immunosuppression. By addressing comorbidities, outcomes could possibly be improved.

Keywords: renal insufficiency, Mortality, Reoperation, Waiting Lists, Kidney Transplantation, frailty

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
I agree