Alexander Kainz1, Michael Kammer1,2, Roman Reindl-Schwaighofer1, Susanne Strohmaier3, Vojtěch Petr4, Ondrej Viklicky4, Daniel Abramowicz5, Marcel Naik6,7, Gert Mayer8,9, Rainer Oberbauer10. 1. Department of Nephrology, Medical University of Vienna, Vienna, Austria. 2. Institute of Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. 3. Department of Epidemiology, Medical University of Vienna, Vienna, Austria. 4. Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 5. Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium. 6. Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin, Berlin, Germany. 7. Berlin Institute of Health, Berlin, Germany. 8. Department of Internal Medicine IV-Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria. 9. Austrian Dialysis and Transplant Registry, Innsbruck, Austria. 10. Department of Nephrology, Medical University of Vienna, Vienna, Austria rainer.oberbauer@meduniwien.ac.at.
Abstract
BACKGROUND AND OBJECTIVES: The median kidney transplant half-life is 10-15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980-2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies "retransplant" versus "remain waitlisted with maintenance dialysis" are reported for different waiting times after first graft loss. RESULTS: Second kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, -14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively. CONCLUSIONS: Second kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.
BACKGROUND AND OBJECTIVES: The median kidney transplant half-life is 10-15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980-2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies "retransplant" versus "remain waitlisted with maintenance dialysis" are reported for different waiting times after first graft loss. RESULTS: Second kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, -14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively. CONCLUSIONS: Second kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.
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Authors: Angela Ju; Michelle A Josephson; Zeeshan Butt; Sheila Jowsey-Gregoire; Jane Tan; Quinetta Taylor; Kevin Fowler; Fabienne Dobbels; Fergus Caskey; Vivekanand Jha; Jayme Locke; Greg Knoll; Curie Ahn; Camilla S Hanson; Benedicte Sautenet; Karine Manera; Jonathan C Craig; Martin Howell; Claudia Rutherford; Allison Tong; Paul Harden; Carmel Hawley; Hallvard Holdaas; Ajay Israni; Michelle Jesse; Brenna Kane; John Kanellis; Bryce Kiberd; Joseph Kim; Chris Larsen; Alan Leichtman; Krista Lentine; Andrew Malone; Roslyn Mannon; Rainer Oberbauer; Rachel Patzer; John Devin Peipert; Hai An Phan; Emilio Poggio; Rihannon Reed; John Scandling; Ignatius Tang; Chris Watson; Daniel Contrares; Patricia Contreras; Daley Cross; Egle Juodvalkis; Den Koide; Jinny Koide; Adam Kozarewicz; Laura Kozarewicz; Richard Kozarewicz; Andrea Koritala; Elizabeth Lisiecki; Christine Lipuma; Margaret Lyman; Robert Mueller; Gloria Mueller; Larry Noble; Nancy Nolan; Stephen Nolan; Jim Thomas; Lynda Urbancyzk; James Zerante; Susan Zerante Journal: Transplantation Date: 2019-06 Impact factor: 4.939