Marco Bonani1, Rita Achermann2, Harald Seeger1, Michael Scharfe3, Thomas Müller1, Stefan Schaub3, Isabelle Binet4, Uyen Huynh-Do5, Suzan Dahdal5, Dela Golshayan6, Karine Hadaya7, Rudolf P Wüthrich1, Thomas Fehr8, Stephan Segerer1,9. 1. Division of Nephrology, University Hospital Zürich, Zürich, Switzerland. 2. Department Transplant Immunology and Nephrology, University Basel Hospital, Basel, Switzerland. 3. Department of Clinical Research, Clinical Trial Unit, University Basel Hospital, Basel, Switzerland. 4. Division of Nephrology/Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland. 5. Department of Nephrology and Hypertension, University of Bern, Bern, Switzerland. 6. Transplantation Center, CHUV University Hospital, Lausanne, Switzerland. 7. Division of Nephrology, Geneva University Hospital, Geneva, Switzerland. 8. Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland. 9. Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland.
Abstract
BACKGROUND: Patients returning to dialysis after graft loss have high early morbidity and mortality. METHODS: We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded. RESULTS: Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft. CONCLUSION: In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.
BACKGROUND:Patients returning to dialysis after graft loss have high early morbidity and mortality. METHODS: We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded. RESULTS: Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft. CONCLUSION: In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.
Authors: Greg Knoll; Patricia Campbell; Michaël Chassé; Dean Fergusson; Tim Ramsay; Priscilla Karnabi; Jeffrey Perl; Andrew A House; Joseph Kim; Olwyn Johnston; Rahul Mainra; Isabelle Houde; Dana Baran; Darin J Treleaven; Lynne Senecal; Lee Anne Tibbles; Marie-Josée Hébert; Christine White; Martin Karpinski; John S Gill Journal: J Am Soc Nephrol Date: 2022-03-23 Impact factor: 14.978