Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis
Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting...
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Wolters Kluwer
2024-11-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001717 |
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| author | Ryan Gately, MMedStat Germaine Wong, PhD Armando Teixeira-Pinto, PhD Helen Pilmore, MD Carmel Hawley, MMedStat Scott Campbell, PhD William Mulley, PhD Wai H. Lim, PhD |
| author_facet | Ryan Gately, MMedStat Germaine Wong, PhD Armando Teixeira-Pinto, PhD Helen Pilmore, MD Carmel Hawley, MMedStat Scott Campbell, PhD William Mulley, PhD Wai H. Lim, PhD |
| author_sort | Ryan Gately, MMedStat |
| collection | DOAJ |
| description | Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN.
Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease.
Results. Of 3276 patients who received a second kidney transplant, 179 (5%) lost their first allograft from recurrent GN. Between 2006 and 2021, 1524 patients with failed first allografts (6% with recurrent GN, 45% with primary GN but no disease recurrence) were relisted for transplantation. Compared with patients without primary GN, the adjusted hazard ratios (95% confidence intervals) for relisting in patients with primary GN, with and without disease recurrence, were 1.09 (0.88-1.34) and 1.16 (1.05-1.29), respectively. The respective adjusted hazard ratios for allograft loss after repeat transplantation were 0.77 (0.59-1) and 1.02 (0.9-1.16). Of the 81 patients who received a second allograft after losing their first allograft to GN recurrence, 18 patients (22%) also lost their second allograft because of recurrent GN.
Conclusions. Patients with prior allograft loss from GN recurrence were not disadvantaged, with comparable waitlist potential and allograft outcome after repeat transplantation. However, >20% of those with prior allograft loss from disease recurrence also lost their second allografts from recurrent disease. |
| format | Article |
| id | doaj-art-196aca57c0e04030a40c8e5bd7eaef16 |
| institution | Kabale University |
| issn | 2373-8731 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj-art-196aca57c0e04030a40c8e5bd7eaef162024-11-26T08:06:28ZengWolters KluwerTransplantation Direct2373-87312024-11-011011e171710.1097/TXD.0000000000001717202411000-00008Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent GlomerulonephritisRyan Gately, MMedStat0Germaine Wong, PhD1Armando Teixeira-Pinto, PhD2Helen Pilmore, MD3Carmel Hawley, MMedStat4Scott Campbell, PhD5William Mulley, PhD6Wai H. Lim, PhD71 Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.2 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.2 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.5 Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.1 Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.1 Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.9 Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia.11 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN. Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease. Results. Of 3276 patients who received a second kidney transplant, 179 (5%) lost their first allograft from recurrent GN. Between 2006 and 2021, 1524 patients with failed first allografts (6% with recurrent GN, 45% with primary GN but no disease recurrence) were relisted for transplantation. Compared with patients without primary GN, the adjusted hazard ratios (95% confidence intervals) for relisting in patients with primary GN, with and without disease recurrence, were 1.09 (0.88-1.34) and 1.16 (1.05-1.29), respectively. The respective adjusted hazard ratios for allograft loss after repeat transplantation were 0.77 (0.59-1) and 1.02 (0.9-1.16). Of the 81 patients who received a second allograft after losing their first allograft to GN recurrence, 18 patients (22%) also lost their second allograft because of recurrent GN. Conclusions. Patients with prior allograft loss from GN recurrence were not disadvantaged, with comparable waitlist potential and allograft outcome after repeat transplantation. However, >20% of those with prior allograft loss from disease recurrence also lost their second allografts from recurrent disease.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001717 |
| spellingShingle | Ryan Gately, MMedStat Germaine Wong, PhD Armando Teixeira-Pinto, PhD Helen Pilmore, MD Carmel Hawley, MMedStat Scott Campbell, PhD William Mulley, PhD Wai H. Lim, PhD Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis Transplantation Direct |
| title | Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis |
| title_full | Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis |
| title_fullStr | Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis |
| title_full_unstemmed | Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis |
| title_short | Access to Waitlisting and Posttransplant Outcomes in Patients With Failed Kidney Allografts Secondary to Recurrent Glomerulonephritis |
| title_sort | access to waitlisting and posttransplant outcomes in patients with failed kidney allografts secondary to recurrent glomerulonephritis |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001717 |
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