Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival
Background. There is an increasing demand for kidney retransplantation. Most studies report inferior outcomes compared to primary transplantation, consequently feeding an ethical dilemma in the context of chronic organ shortage. Objective. To assess variables influencing long-term graft survival aft...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2022/3397751 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849435002887995392 |
|---|---|
| author | Jonas Ehrsam Fabian Rössler Karoline Horisberger Kerstin Hübel Jakob Nilsson Olivier de Rougemont |
| author_facet | Jonas Ehrsam Fabian Rössler Karoline Horisberger Kerstin Hübel Jakob Nilsson Olivier de Rougemont |
| author_sort | Jonas Ehrsam |
| collection | DOAJ |
| description | Background. There is an increasing demand for kidney retransplantation. Most studies report inferior outcomes compared to primary transplantation, consequently feeding an ethical dilemma in the context of chronic organ shortage. Objective. To assess variables influencing long-term graft survival after kidney retransplantation. Material and Methods. All patients transplanted at our center between 2000 and 2016 were analyzed retrospectively. Survival was estimated with the Kaplan–Meier method, and risk factors were identified using multiple Cox regression. Results. We performed 1,376 primary kidney transplantations and 222 retransplantations. The rate of retransplantation was 67.8% after the first graft loss, with a comparable 10-year graft survival compared to primary transplantation (67% vs. 64%, p=0.104) but an inferior graft survival thereafter (log-rank p=0.026). Independent risk factors for graft survival in retransplantation were age ≥ 50 years, time on dialysis ≥1 year, previous graft survival <2 years, ≥1 mild comorbidity in the Charlson–Deyo index, active smoking, and life-threatening complications (Clavien–Dindo grade IV) at first transplantation. Conclusion. Graft survival is comparable for first and second kidney transplantation within the first 10 years. Risk factors for poor outcomes after retransplantation are previous graft survival, dialysis time after graft failure, recipient age, comorbidities, and smoking. Patients with transplant failure should have access to retransplantation as early as possible. |
| format | Article |
| id | doaj-art-e4b570fb9baa4523b25be51ae6d01f91 |
| institution | Kabale University |
| issn | 2090-0015 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-e4b570fb9baa4523b25be51ae6d01f912025-08-20T03:26:26ZengWileyJournal of Transplantation2090-00152022-01-01202210.1155/2022/3397751Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term SurvivalJonas Ehrsam0Fabian Rössler1Karoline Horisberger2Kerstin Hübel3Jakob Nilsson4Olivier de Rougemont5Department of Thoracic SurgeryDepartment of Surgery and TransplantationDepartment of Surgery and TransplantationDepartment of Surgery and TransplantationDepartment of ImmunologyDepartment of Surgery and TransplantationBackground. There is an increasing demand for kidney retransplantation. Most studies report inferior outcomes compared to primary transplantation, consequently feeding an ethical dilemma in the context of chronic organ shortage. Objective. To assess variables influencing long-term graft survival after kidney retransplantation. Material and Methods. All patients transplanted at our center between 2000 and 2016 were analyzed retrospectively. Survival was estimated with the Kaplan–Meier method, and risk factors were identified using multiple Cox regression. Results. We performed 1,376 primary kidney transplantations and 222 retransplantations. The rate of retransplantation was 67.8% after the first graft loss, with a comparable 10-year graft survival compared to primary transplantation (67% vs. 64%, p=0.104) but an inferior graft survival thereafter (log-rank p=0.026). Independent risk factors for graft survival in retransplantation were age ≥ 50 years, time on dialysis ≥1 year, previous graft survival <2 years, ≥1 mild comorbidity in the Charlson–Deyo index, active smoking, and life-threatening complications (Clavien–Dindo grade IV) at first transplantation. Conclusion. Graft survival is comparable for first and second kidney transplantation within the first 10 years. Risk factors for poor outcomes after retransplantation are previous graft survival, dialysis time after graft failure, recipient age, comorbidities, and smoking. Patients with transplant failure should have access to retransplantation as early as possible.http://dx.doi.org/10.1155/2022/3397751 |
| spellingShingle | Jonas Ehrsam Fabian Rössler Karoline Horisberger Kerstin Hübel Jakob Nilsson Olivier de Rougemont Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival Journal of Transplantation |
| title | Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival |
| title_full | Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival |
| title_fullStr | Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival |
| title_full_unstemmed | Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival |
| title_short | Kidney Retransplantation after Graft Failure: Variables Influencing Long-Term Survival |
| title_sort | kidney retransplantation after graft failure variables influencing long term survival |
| url | http://dx.doi.org/10.1155/2022/3397751 |
| work_keys_str_mv | AT jonasehrsam kidneyretransplantationaftergraftfailurevariablesinfluencinglongtermsurvival AT fabianrossler kidneyretransplantationaftergraftfailurevariablesinfluencinglongtermsurvival AT karolinehorisberger kidneyretransplantationaftergraftfailurevariablesinfluencinglongtermsurvival AT kerstinhubel kidneyretransplantationaftergraftfailurevariablesinfluencinglongtermsurvival AT jakobnilsson kidneyretransplantationaftergraftfailurevariablesinfluencinglongtermsurvival AT olivierderougemont kidneyretransplantationaftergraftfailurevariablesinfluencinglongtermsurvival |