BACKGROUND: Information to guide the timing of a second kidney transplantation is limited. METHODS: We compared outcomes of 3509 preemptive and 14,075 nonpreemptive second kidney transplant recipients in the U.S. Renal Data System between 1995 and 2007. RESULTS: Preemptive recipients had less acute rejection (12% vs. 16%; P<0.0001) and delayed graft function (8% vs. 23%; P<0.0001). Preemptive transplantation was associated with a lower multivariate adjusted risk of allograft failure from any cause including death (hazard ratio [HR], 0.88; 95% confidence interval [95% CI], 0.81-0.96) and death with a functioning graft (HR [95% CI], 0.76 [0.66-0.87]) but a similar risk of death-censored graft loss (HR [95% CI], 0.98 [0.88-1.08]). The benefits of preemptive transplantation were evident in all patients groups with first transplant survival equal to or more than 1 year; however, a 34% increased risk of death-censored graft loss was observed in preemptive recipients when first transplant survival was less than 1 year. CONCLUSIONS: Benefits and risks of preemptive transplantation vary between primary and second transplant recipients. Benefits in second transplant recipients are primarily due to decreased death with a functioning graft, with no difference in death-censored graft survival. Preemptive transplantation was beneficial when first transplant survival was equal to or more than 1 year but associated with increased risk when graft survival was less than 1 year.
BACKGROUND: Information to guide the timing of a second kidney transplantation is limited. METHODS: We compared outcomes of 3509 preemptive and 14,075 nonpreemptive second kidney transplant recipients in the U.S. Renal Data System between 1995 and 2007. RESULTS: Preemptive recipients had less acute rejection (12% vs. 16%; P<0.0001) and delayed graft function (8% vs. 23%; P<0.0001). Preemptive transplantation was associated with a lower multivariate adjusted risk of allograft failure from any cause including death (hazard ratio [HR], 0.88; 95% confidence interval [95% CI], 0.81-0.96) and death with a functioning graft (HR [95% CI], 0.76 [0.66-0.87]) but a similar risk of death-censored graft loss (HR [95% CI], 0.98 [0.88-1.08]). The benefits of preemptive transplantation were evident in all patients groups with first transplant survival equal to or more than 1 year; however, a 34% increased risk of death-censored graft loss was observed in preemptive recipients when first transplant survival was less than 1 year. CONCLUSIONS: Benefits and risks of preemptive transplantation vary between primary and second transplant recipients. Benefits in second transplant recipients are primarily due to decreased death with a functioning graft, with no difference in death-censored graft survival. Preemptive transplantation was beneficial when first transplant survival was equal to or more than 1 year but associated with increased risk when graft survival was less than 1 year.
Authors: Alexander Kainz; Michael Kammer; Roman Reindl-Schwaighofer; Susanne Strohmaier; Vojtěch Petr; Ondrej Viklicky; Daniel Abramowicz; Marcel Naik; Gert Mayer; Rainer Oberbauer Journal: Clin J Am Soc Nephrol Date: 2021-12-29 Impact factor: 8.237
Authors: Miriam C Banas; Georg A Böhmig; Ondrej Viklicky; Lionel P Rostaing; Thomas Jouve; Lluis Guirado; Carme Facundo; Oriol Bestard; Hermann-Josef Gröne; Kazuhiro Kobayashi; Vladimir Hanzal; Franz Josef Putz; Daniel Zecher; Tobias Bergler; Sindy Neumann; Victoria Rothe; Amauri G Schwäble Santamaria; Eric Schiffer; Bernhard Banas Journal: Front Med (Lausanne) Date: 2022-01-07
Authors: Anke Schwarz; Frank Schäfer; Theodor Framke; Silvia Linnenweber-Held; Nicolas Richter; Hermann Haller Journal: Ann Transplant Date: 2021-07-16 Impact factor: 1.530