Outcome of kidney transplant in primary, repeat, and kidney‐after‐nonrenal solid‐organ transplantation: 15‐year analysis of recent UNOS database

Abstract

The number of nonrenal solid-organ transplants increased substantially in the last few decades. Many of these patients develop renal failure and receive kidney transplantation. The aim of this study was to evaluate patient and kidney allograft survival in primary, repeat, and kidney-after-nonrenal organ transplantation using national data reported to United Network for Organ Sharing (UNOS) from January 2000 through December 2014. Survival time for each patient was stratified into the following: Group A (comparison group)-recipients of primary kidney transplant (178 947 patients), Group B-recipients of repeat kidney transplant (17 819 patients), and Group C-recipients of kidney transplant performed after either a liver, heart, or lung transplant (2365 patients). We compared survivals using log-rank test. Compared to primary or repeat kidney transplant, patient and renal allograft survival was significantly lower in those with previous nonrenal organ transplant. Renal allograft and patient survival after liver, heart, or lung transplants are comparable. Death was the main cause of graft loss in patients who had prior nonrenal organ transplant.

Trends in the Causes of Death among Kidney Transplant Recipients in the United States (1996–2014)

“…These results were consistent, both in analyses focusing on short-term and on long-term follow up, as well as among both younger patients and those older than 65 years. Our findings extend previous observations conducted in other studies that used considerably older data and had relatively smaller sample sizes 3,7,8 . Ojo et al examined the UNOS/SRTR and USRDS databases to study death with graft function (DWGF) among patients who received their first kidney transplantation from 1988 to 1997 3 .…”

“…Although alarming, a high fraction of missing or unknown cause of death was also shown by previous studies involving national registries 3,7,23 . Missing data does not seem to have affected the contribution of various causes of death, as our results are generally consistent with other studies of mortality where cardiovascular disease, infection and malignancy are the three leading causes of death in patients with KTRs 3,7 . A large retrospective study in an integrated health system (IHS) in the United States (with no missing data) had similar conclusion regarding the causes of mortality 8 .…”

“…This study included 86,502 patients and showed an overall 31% reduction in DWGF among patients who received a kidney transplant from 1993–1997, compared to patients who were transplanted from 1988–1992. El Husseini et al studied patient and graft survival in first-time kidney transplant recipients in UNOS database from 2000–2014 7 . However, their objective was to compare survival in this group to repeat kidney transplants and kidney-after-nonrenal solid organ transplant, and they studied death with a functioning graft as well as death with graft loss.…”

Long-Term Redistribution of Peripheral Lymphocyte Subpopulations after Switching from Calcineurin to mTOR Inhibitors in Kidney Transplant Recipients

“…1.4 (0.5) 1.3 (0.4) 0.286 eGFR at the start of study (mL/min/1.73 m 2 ) (mean (SD)) 57 (21) 59 (14) 0.763 pCOR < 500 mg/g at the start of study (yes) (n, %) 16 (100%) 29 (100%) NA Creatinine at the end of study (mg/dL) (mean (SD))…”

“…Regardless of the use of this immunosuppressive strategy, development of antibody-mediated rejection (ABMR), a form of rejection associated with donor-specific antibodies (DSA), is a major cause of graft loss [8][9][10][11][12]. Death accounts for around half of graft-losses, mainly due to cardiovascular disease, cancer, or infections [13,14]. These results reflect an unmet need of new immunosuppressive therapeutic regimens more efficient for improving long-term survival rates.…”