Pre-Emptive Retransplantation in Patients With Chronic Kidney Graft Failure

Florit, Enrique; Bennis, S.; Rodríguez, Ezequiel; Revuelta, Ignacio; Sousa, Emanuel A.; Esforzado, Núria; Cofán, Frederic; Ricart, M.J.; Torregrosa, José-Vicente; Campistol, Josep M.; Oppenheimer, F.; Diekmann, Fritz

doi:10.1016/j.transproceed.2015.09.003

Cited by 15 publications

(11 citation statements)

References 9 publications

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“…Direct assessment of the comparative effectiveness of transplantation versus remaining on dialysis through a randomized controlled trial is infeasible due to ethical, biologic, and logistic reasons. However, many of the published studies addressing this comparison used conventional observational study designs with a high risk to overestimate potentially better survival with transplantation due to several methodologic issues (8 –16). Key among these are immortal time bias due to the wrong attribution of events to the two groups, often caused by ignoring the time-dependent nature of the treatment group status, and selection bias, as outcomes for patients with transplants are compared with individuals on dialysis not eligible for transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…About 60% of patients with a failing first kidney allograft are eligible to be waitlisted for a second kidney transplantation, and patients awaiting retransplantation represent 28% of all waitlisted patients in Austria (5)(6)(7). Observational studies have reported that a second kidney transplantation also offers better survival and quality of life compared with remaining on dialysis, but these findings are generally at a high risk of selection or immortal time bias (8)(9)(10)(11)(12)(13)(14)(15)(16). A clinical trial establishing comparative effectiveness of transplantation is, however, infeasible for ethical and logistic reasons.…”

Section: Introductionmentioning

confidence: 99%

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Waiting Time for Second Kidney Transplantation and Mortality

Kainz

Kammer

Reindl‐Schwaighofer

et al. 2022

CJASN

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Background and objectivesThe median kidney transplant half-life is 10–15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list.Design, setting, participants, & measurementsIn this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980–2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies “retransplant” versus “remain waitlisted with maintenance dialysis” are reported for different waiting times after first graft loss.ResultsSecond kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, −14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively.ConclusionsSecond kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Waiting Time for Second Kidney Transplantation and Mortality

Kainz

Kammer

Reindl‐Schwaighofer

et al. 2022

CJASN

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“…When living donor KT is not feasible, preemptive deceased-donor kidney retransplantation represents the optimal therapy for patients who lose kidney allograft, exhibiting greater patient and graft survival, thanks to avoiding the morbidity and mortality associated with dialysis reinitiation [ 3 , 15 , 20 ]. However, this option is not always possible due to patient comorbidities or limited because of HLA sensitization, or by the fact that time on dialysis is a relevant criterion in our allocation score.…”

Section: Discussionmentioning

confidence: 99%

Effect of kidney replacement therapy modality after first kidney graft failure on second kidney transplantation outcomes

Couceiro

Rama

Comas³

et al. 2022

Clinical Kidney Journal

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Background There is lack of information regarding which is the best dialysis technique after kidney transplant (KT) failure. The aim of this study is to compare the effect of kidney replacement therapy modality -peritoneal dialysis (TX-PD-TX), hemodialysis (TX-HD-TX) and preemptive deceased donor retransplantation (TX-TX)- on patient survival and second KT outcomes. Methods A retrospective observational study from the Catalan Renal Registry was carried out. We included adult patients with failing of their first KT from 2000 to 2018. Results Among 2,045 patients, 1,829 started on HD (89.4%), 168 on PD (8.2%) and 48 (2.4%) received a preemptive KT. Non-inclusion in the KT waiting list and HD were associated with worse patient survival. For patients included in the waiting list, the probability of HLA sensitization and to receive a second KT was similar in HD and PD. 776 patients received a second KT (38%), 656 in TX-HD-TX, 72 in TX-PD-TX and 48 in TX-TX groups. Adjusted mortality after second KT was higher in TX-HD-TX patients compared with TX-TX and TX-PD-TX groups, without differences between TX-TX and TX-PD-TX group. Death-censored second graft survival was similar in all 3 groups. Conclusions Our results suggest that after first KT failure, PD is superior to HD in reducing mortality in candidates for a second KT without options for preemptive retransplantation.

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“…Preemptive transplantation is associated with significantly better graft and patient survival, especially when a living donor is available [ 97 , 98 ]. Preemptive retransplantation adds other benefits that are extremely valuable for graft and patient survival: it is performed under full immunosuppressive treatment and first allograft is not removed, preventing HLA sensitization [ 99 ]. Also, the higher mortality rates in dialysis while on the waiting list, are overcome, vascular capital is preserved and the patients gain significant quality of life [ 33 ].…”

Section: Strategies To Increase Retransplantation Access ( ...mentioning

confidence: 99%

Strategies to Overcome HLA Sensitization and Improve Access to Retransplantation after Kidney Graft Loss

Leal

Pardinhas

Martinho

et al. 2022

JCM

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An increasing number of patients waitlisted for kidney transplantation have a previously failed graft. Retransplantation provides a significant improvement in morbidity, mortality, and quality of life when compared to dialysis. However, HLA sensitization is a major barrier to kidney retransplantation and the majority of the highly sensitized patients are waiting for a subsequent kidney transplant. A multidisciplinary team that includes immunogeneticists, transplant nephrologists and surgeons, and adequate allocation policies is fundamental to increase access to a kidney retransplant. A review of Pubmed, ScienceDirect, and the Cochrane Library was performed on the challenges of kidney retransplantation after graft loss, focusing on the HLA barrier and new strategies to overcome sensitization. Conclusion: Technical advances in immunogenetics, new desensitization protocols, and complex allocation programs have emerged in recent years to provide a new hope to kidney recipients with a previously failed graft.

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Pre-Emptive Retransplantation in Patients With Chronic Kidney Graft Failure

Cited by 15 publications

References 9 publications

Waiting Time for Second Kidney Transplantation and Mortality

Waiting Time for Second Kidney Transplantation and Mortality

Effect of kidney replacement therapy modality after first kidney graft failure on second kidney transplantation outcomes

Strategies to Overcome HLA Sensitization and Improve Access to Retransplantation after Kidney Graft Loss

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