Outcomes in Third and Fourth Kidney Transplants Based on the Type of Donor

Dabare, Dilan; Kassimatis, Theodoros; Hodson, James; Khurram, Muhammad; Papadakis, Georgios; Rompianesi, Gianluca; Shaw, Olivia; Karydis, Nikolaos; Callaghan, Chris; Olsburgh, Jonathon; Mamode, Nizam; Kessaris, Nicos; Loukopoulos, Ioannis

doi:10.1097/tp.0000000000002428

Cited by 14 publications

(19 citation statements)

References 29 publications

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“…Multivariable modeling accounting for confounding factors revealed significantly worse survival for 3rd and ≥4th DDRTs as compared to recipients of a 1st DDRT contradictory to previous reports (Table a; Fig. a).…”

Section: Discussioncontrasting

confidence: 99%

“…In previous studies, graft survival in 3rd compared to 1st DDRT recipients was similar or decreased . In our study, a significantly increased cumulative incidence of graft loss for 3rd and ≥4th DDRTs as compared to 1st DDRTs was identified (Tables and a; Fig.…”

Section: Discussionsupporting

confidence: 75%

“…In our study, recipients of more than two sequential grafts had a shorter graft and patient survival than any other group. The results emphasize the benefit of HLA matching in first and second DDRT . Further studies should be initiated to evaluate the expected positive impact of well‐matched first and second kidney transplantations on a reduction of repeated re‐transplantations on the one hand and a better graft survival of these 3rd and ≥4th grafts due to lower immunization levels on the other hand in future.…”

Section: Discussionmentioning

confidence: 77%

“…Whereas outcome of repeated re‐transplantation has been analyzed in the UNOS/OPTN area and some single‐transplant centers , there exists no comprehensive analysis on the respective collective of repeated re‐DDRT recipients in the Eurotransplant Kidney Allocation System (ETKAS) and Eurotransplant Senior Program (ESP).…”

Section: Introductionmentioning

confidence: 99%

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Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

et al. 2020

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In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re-transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15-year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re-DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and ≥4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re-DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re-DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for ≥4th DDRT.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

et al. 2020

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“…Another important advantage offered by living donation is that an elective operation allows diligent planning and the presence of additional surgical expertise for complex cases [24]. This might also contribute to better outcomes, independently from the quality of the donor [19], with a standardised elective procedure taking place at an optimal time and that, despite being a major operation, has a minor impact [25] on the recovery of the healthy donor, who usually can plan ahead for time off work, for family care for and for a full recovery.…”

Section: Discussionmentioning

confidence: 99%

Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

Bellini

Courtney

McCaughan

2020

JCM

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Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.

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Outcomes of first versus third kidney transplantations: propensity score matching and paired subgroup analysis—a single-centre experience

Telkes

Piros

Szabó

et al. 2021

Langenbecks Arch Surg

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Background In the Eurotransplant, 12.6% of kidney transplantations are a repeat procedure. Third transplants are significantly more complex than first and second ones. We compared the results of first (PRT) versus third (TRT) transplantations. Methods Between 2011 and 2016, we performed 779 deceased donor adult kidney transplantations, 14.2% out of them were second, 2.6% (20) third, and 0.3% fourth. We compared the pre-, intra-, and postoperative data, kidney function, and survival rate. Results Recipients of TRT were younger (53.4 vs. 47.3 p = 0.02). HCV infection rate (20%, p = 0.00) is ten times higher. The operation time is longer (132 vs. 152 min, p = 0.02), and delayed graft function is much more frequent (22.4% vs. 60%, p = 0.00). Induction therapy was given to every TRT (7.9% vs.100%), but as a result, the rejection rate was the same (~ 15%). Hospital stay is a week longer. Patient’s survival at 1, 3, and 5 years for PRT is 96.4%, 93.9%, and 91.2% and for TRT is 90%, 85%, and 78.4%, respectively (p = 0.023). TRT’s odds ratio of fatal outcome is 4.35 (1.5–12.5). Graft survival at 1, 3, and 5 years for PRT is 93.1%, 91.4%, and 90.3% and for TRT is 75%, 75%, and 75%, respectively (p = 0.020). TRT’s odds ratio of graft loss is 3.14 (1.1–8.9). Of PRT 85.76%, out of PRT 85.76%, while out of TRT 60% live with a functioning graft, p=0.00149. Conclusion In a third transplant, both graft and patient survival are significantly inferior to primer ones. Careful selection is required to minimize the patient risk and graft loss.

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Outcomes in Third and Fourth Kidney Transplants Based on the Type of Donor

Cited by 14 publications

References 29 publications

Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

Outcomes of first versus third kidney transplantations: propensity score matching and paired subgroup analysis—a single-centre experience

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