Repeat Organ Transplantation in the United States, 1996–2005

Abstract

The prospect of graft loss is a problem faced by all transplant recipients, and retransplantation is often an option when loss occurs. To assess current trends in retransplantation, we analyzed data for retransplant candidates and recipients over the last 10 years, as well as current outcomes. During 2005, retransplant candidates represented 13.5%, 7.9%, 4.1% and 5.5% of all newly registered kidney, liver, heart and lung candidates, respectively. At the end of 2005, candidates for retransplantation accounted for 15.3% of kidney transplant candidates, and lower proportions of liver (5.1%), heart (5.3%) and lung (3.3%) candidates. Retransplants represented 12.4% of kidney, 9.0% of liver, 4.7% of heart and 5.3% of lung transplants performed in 2005. The absolute number of retransplants has grown most notably in kidney transplantation, increasing 40% over the last 10 years; the relative growth of retransplantation was most marked in heart and lung transplantation, increasing 66% and 217%, respectively. The growth of liver retransplantation was only 11%. Unadjusted graft survival remains significantly lower after retransplantation in the most recent cohorts analyzed. Even with careful case mix adjustments, the risk of graft failure following retransplantation is significantly higher than that observed for primary transplants.

Risk Factors for Retransplant Kidney Recipients: Relisting and Outcomes From Patients’ Primary Transplant

“…In 2011, 11.8% of recipients of kidney transplants were retransplants in the United States (2). In the decade prior to 2007, the number of kidney retransplants increased by 40% due to a greater number of renal transplants performed and to a greater number of patients suffering from allograft loss (3,4). This trend will likely continue to rise given the increased use of marginal donor organs and higher-risk recipients receiving transplantation (4).…”

“…More than half of the cases of primary graft failure that occur in the first year are attributed to acute rejection and graft thrombosis (3). If the primary loss occurs more than a year after transplantation, one study suggests that chronic rejection accounts for almost two-thirds of graft losses (3).…”

“…Overall, retransplant recipients have a higher panel reactive antibody (PRA) level at listing compared to primary recipients, which accounts for part of the high-risk nature of regraft kidney recipients and the decreased likelihood to receive a donor transplant rapidly (3,4). More than half of the cases of primary graft failure that occur in the first year are attributed to acute rejection and graft thrombosis (3).…”

Canadian Cardiovascular Society Consensus Conference update on cardiac transplantation 2008: Executive Summary

“…Patients who are younger, those who are retransplanted more than one year after the initial transplant, and those with either graft vasculopathy or chronic rejection as the reason for retransplantation have more reasonable outcomes. There is debate about the appropriateness of retransplantation but the final decision for suitability of retransplantation resides with the transplant physicians and the local review process (38,95,96).…”

Being Thoughtful about Desensitization

“…Therefore, although desensitization therapy in the short term allows for kidney transplantation sooner, it does not seem to confer the same benefit of longer-term graft survival achieved through compatible kidney transplants. Premature allograft failure results in greater sensitization, making subsequent transplants more challenging, with resultant worse 1-, 3-, and 5-year graft survival compared those rates of first-time transplant recipients (10).…”