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

Aßfalg, Volker; Selig, Katharina; Tolksdorf, Johanna; Meel, Marieke van; Vries, Erwin de; Ramsoebhag, Anne-Marie; Rahmel, Axel; Renders, Lutz; Novotny, Alexander; Matevossian, Edouard; Schneeberger, Stefan; Rosenkranz, Alexander R.; Berlakovich, Gabriela; Ysebaert, Dirk; Knops, Noël; Weekers, Laurent; Muehlfeld, Anja; Rump, L. C.; Hauser, Ingeborg A.; Pisarski, Przemyslaw; Weimer, Rolf; Fornara, Paolo; Fischer, Lutz; Kliem, Volker; Sester, Urban; Stippel, Dirk L.; Arns, Wolfgang; Hau, Hans-Michael; Nitschke, Martin; Hoyer, Joachim; Thorban, Stefan; Weinmann‐Menke, Julia; Heller, Katharina; Banas, Bernhard; Schwenger, Vedat; Nadalin, Silvio; Lopau, Kai; Hüser, Norbert; Heemann, Uwe

doi:10.1111/tri.13569

Cited by 16 publications

(27 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001); this is unsurprising, as more highly sensitised patients require better matched kidneys. Our results are in contrast to a recent European multicentre analysis reporting that mortality and graft loss after 3rd+ KTRs were higher as compared to 1st KTRs, despite receiving grafts with more favourable HLA matches [17]. More in detail, Assfalg et al analysed the outcomes of 1464 patients from 42 centres in the Eurotransplant area who received a third or fourth kidney transplant in the period 1996-2010, confirming a younger age compared to first transplant recipients, a more frequently favourable HLA match, but a higher rate of graft loss, death with functioning graft and primary non-function.…”

Section: Discussioncontrasting

confidence: 99%

“…As previously stated, in fact the graft nephrectomy would imply the cessation of the immunosuppression, giving rise to antibody production due to the persistence of donor antigen-presenting cells after the transplantectomy. Furthermore, with the evidence that HLA matching plays a fundamental role in the context of repeated kidney transplantation, from the present study and another large registry analysis [17], we think that a synergistic approach to optimise the recipient condition and general immunological status would better satisfy increased complexity at the moment of transplantation in the eventuality that a prolonged surgical time would be required to find a suitable implantation site. Once again, we emphasize the importance of a high-quality graft, like the one retrieved from a living donor, to better resist a prolonged ischaemic insult.…”

Section: Discussionmentioning

confidence: 65%

See 1 more Smart Citation

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

Bellini

Courtney

McCaughan

2020

JCM

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 65%

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

Bellini

Courtney

McCaughan

2020

JCM

View full text Add to dashboard Cite

show abstract

“…This observation is in accordance with a recent publication of Assfalg et al . [20] who report a significantly younger age for third and fourth kidney transplant recipients and also with previous reports of UNOS/OPTN data [21,22]. Patients after repeated allograft failure represent a group of recipients that get a first transplant early in life and end up with transplant failure earlier in life again.…”

Section: Discussionmentioning

confidence: 69%

What happens after graft loss? A large, long‐term, single‐center observation

et al. 2021

View full text Add to dashboard Cite

Summary The number of patients returning to dialysis after graft failure increases. Surprisingly, little is known about the clinical and immunological outcomes of this cohort. We retrospectively analyzed 254 patients after kidney allograft loss between 1997 and 2017 and report clinical outcomes such as mortality, relisting, retransplantations, transplant nephrectomies, and immunization status. Of the 254 patients, 49% had died 5 years after graft loss, while 27% were relisted, 14% were on dialysis and not relisted, and only 11% were retransplanted 5 years after graft loss. In the complete observational period, 111/254 (43.7%) patients were relisted. Of these, 72.1% of patients were under 55 years of age at time of graft loss and only 13.5% of patients were ≥65 years. Age at graft loss was associated with relisting in a logistic regression analysis. In the complete observational period, 42 patients (16.5%) were retransplanted. Only 4 of those (9.5%) were ≥65 years at time of graft loss. Nephrectomy had no impact on survival, relisting, or development of dnDSA. Patients after allograft loss have a high overall mortality. Immunization contributes to long waiting times. Only a very limited number of patients are retransplanted especially when ≥65 years at time of graft loss.

show abstract

“…In the current issue of Transplant International, Assfalg et al address the question whether, in times of organ shortage, it is justified to perform a repeat kidney re‐transplant (e.g. third or fourth transplant).…”

Section: Figurementioning

confidence: 99%

“…Deceased donor kidney transplantations performed at European CTS centres during (a) 1996–2010, the period considered in the manuscript of Assfalg et al , and (b) the more recent era 2011–2018. From 1996–2010 to 2011–2018, there was a general improvement of graft survival, which was especially pronounced in recipients of a fourth graft (red curve) who in the meantime show a similar outcome as third graft recipients (orange curve).…”

Section: Figurementioning

confidence: 99%