Germaine Wong1, Samantha Chua, Steven J Chadban, Philip Clayton, Helen Pilmore, Peter D Hughes, Paolo Ferrari, Wai H Lim. 1. 1 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.2 Sydney School of Public Health, University of Sydney, New South Wales, Australia.3 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia.4 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.5 Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia.6 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.7 Renal Unit, Auckland Hospital, Auckland, New Zealand.8 Department of Medicine, Auckland University, Auckland, New Zealand.9 Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia.10 Prince of Wales Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: The number of patients with end-stage renal disease being relisted for a second kidney transplant is increasing worldwide. The aim of this study was to determine the relationship between waiting time for a second transplant and outcomes after that second transplant. METHODS: Using Australia and New Zealand Dialysis and Transplant registry, patients who have received second kidney transplants between 1997 and 2009 were included. The associations between waiting time, defined as duration of dialysis between first allograft failure and second transplantation, and clinical outcomes including acute rejection, graft and patient survival were examined using adjusted logistic and Cox regression models. RESULTS: Of the 911 recipients, the median follow-up time was 4.7 years resulting in 4825 person-years of follow-up. Increasing waiting time before second transplants was associated with an increased risk of early acute rejection occurring within the first 6 months after transplant (adjusted odds ratio, 1.11; 95% confidence interval [95% CI], 1.06-1.16; P < 0.001), severe vascular and/or humoral rejection (adjusted odds ratio, 1.06; 95% CI, 1.01-1.11; P = 0.011), overall graft failure (adjusted hazard ratio [HR], 1.06; 95% CI, 1.02-1.10; P = 0.001), all-cause mortality (adjusted HR, 1.13; 95% CI, 1.07-1.19; P < 0.001), and death with a functioning graft (adjusted HR, 1.12; 95% CI, 1.06-1.18; P < 0.001), independent of donor, recipient, and immunological factors. CONCLUSIONS: Prolonged waiting time for a second transplant was associated with inferior patient and graft outcomes.
BACKGROUND: The number of patients with end-stage renal disease being relisted for a second kidney transplant is increasing worldwide. The aim of this study was to determine the relationship between waiting time for a second transplant and outcomes after that second transplant. METHODS: Using Australia and New Zealand Dialysis and Transplant registry, patients who have received second kidney transplants between 1997 and 2009 were included. The associations between waiting time, defined as duration of dialysis between first allograft failure and second transplantation, and clinical outcomes including acute rejection, graft and patient survival were examined using adjusted logistic and Cox regression models. RESULTS: Of the 911 recipients, the median follow-up time was 4.7 years resulting in 4825 person-years of follow-up. Increasing waiting time before second transplants was associated with an increased risk of early acute rejection occurring within the first 6 months after transplant (adjusted odds ratio, 1.11; 95% confidence interval [95% CI], 1.06-1.16; P < 0.001), severe vascular and/or humoral rejection (adjusted odds ratio, 1.06; 95% CI, 1.01-1.11; P = 0.011), overall graft failure (adjusted hazard ratio [HR], 1.06; 95% CI, 1.02-1.10; P = 0.001), all-cause mortality (adjusted HR, 1.13; 95% CI, 1.07-1.19; P < 0.001), and death with a functioning graft (adjusted HR, 1.12; 95% CI, 1.06-1.18; P < 0.001), independent of donor, recipient, and immunological factors. CONCLUSIONS: Prolonged waiting time for a second transplant was associated with inferior patient and graft outcomes.
Authors: B A Shelton; S Mehta; D Sawinski; R D Reed; P A MacLennan; S Gustafson; D L Segev; J E Locke Journal: Am J Transplant Date: 2016-07-19 Impact factor: 8.086
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: Domingo Hernández; Alfonso Muriel; Pablo Castro de la Nuez; Juana Alonso-Titos; Pedro Ruiz-Esteban; Ana Duarte; Miguel Gonzalez-Molina; Eulalia Palma; Manuel Alonso; Armando Torres Journal: PLoS One Date: 2018-03-07 Impact factor: 3.240
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: Aesha Maniar; David K Hooper; Christine B Sethna; Pamela Singer; Avram Traum; Elizabeth Benoit; Elizabeth Kotzen; Priya Verghese; Rouba Garro; Margaret Kamel; Daniel Ranch; Weiwen Shih; Namrata G Jain; Samhar Al-Akash Journal: Pediatr Transplant Date: 2021-07-11