Kidney medicine · 2025
Repeat Transplantation Rate of Patients Receiving Dialysis After Allograft Nephrectomy.
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Achinger Steven G, Ayus Juan Carlos, Kumar Ambuj, Tsalatsanis Athanasios
Аннотация
RATIONALE & OBJECTIVE: Allograft failure has been associated with chronic inflammation and poor survival among dialysis patients after allograft failure. Allograft nephrectomy is associated with higher levels of anti-human alloantibodies, making it more difficult to find matching kidney donors; however, the rate of repeat transplantation following allograft nephrectomy is largely unknown.
STUDY DESIGN: A retrospective, propensity score-matched cohort study.
SETTING & PARTICIPANTS: Using the US Renal Data System, we identified adult dialysis patients after a failed kidney transplant between January 1, 1995, and December 31, 2015. A total of 50,217 patients met the inclusion criteria.
EXPOSURE: Kidney allograft nephrectomy.
OUTCOMES: Primary outcome was repeat kidney transplantation.
ANALYTICAL APPROACH: Exposure to nephrectomy was modeled as a time-varying event. We estimated the cumulative incidence of repeat kidney transplant using the competing risk approach. After propensity score matching, 9,696 patients remained in each cohort.
RESULTS: Overall, patients with nephrectomy had higher chances of receiving a second transplant (subdistribution HR, 1.21; 95% CI, 1.15-1.28; P < 0.001). The cumulative incidence of second transplant in the nephrectomy group was 19%, 28%, and 31% at 5, 10, and 20 years, respectively, versus 16%, 24%, and 27% in the comparison group.
LIMITATIONS: As a retrospective, registry-based study, cause and effect relationship cannot be established.
CONCLUSIONS: Allograft nephrectomy of a failed kidney allograft is associated with a higher likelihood of repeat transplantation and should not be considered contraindicated in dialysis patients who are candidates for repeat transplantation.
STUDY DESIGN: A retrospective, propensity score-matched cohort study.
SETTING & PARTICIPANTS: Using the US Renal Data System, we identified adult dialysis patients after a failed kidney transplant between January 1, 1995, and December 31, 2015. A total of 50,217 patients met the inclusion criteria.
EXPOSURE: Kidney allograft nephrectomy.
OUTCOMES: Primary outcome was repeat kidney transplantation.
ANALYTICAL APPROACH: Exposure to nephrectomy was modeled as a time-varying event. We estimated the cumulative incidence of repeat kidney transplant using the competing risk approach. After propensity score matching, 9,696 patients remained in each cohort.
RESULTS: Overall, patients with nephrectomy had higher chances of receiving a second transplant (subdistribution HR, 1.21; 95% CI, 1.15-1.28; P < 0.001). The cumulative incidence of second transplant in the nephrectomy group was 19%, 28%, and 31% at 5, 10, and 20 years, respectively, versus 16%, 24%, and 27% in the comparison group.
LIMITATIONS: As a retrospective, registry-based study, cause and effect relationship cannot be established.
CONCLUSIONS: Allograft nephrectomy of a failed kidney allograft is associated with a higher likelihood of repeat transplantation and should not be considered contraindicated in dialysis patients who are candidates for repeat transplantation.