BACKGROUND: Survival of transplant recipients after primary renal allograft failure has not been well studied. METHODS: A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996. The mortality, wait-listing, and repeat transplantation rates were assessed. The mortality risks associated with repeat transplantation were estimated with a time-dependent survival model. RESULTS: In total, 34.5% (n=6,631) of patients died during follow-up. Of these deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients. Before repeat transplantation, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal disease, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Americans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other races, respectively (P<0.0001 each). Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. CONCLUSIONS: The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.
BACKGROUND: Survival of transplant recipients after primary renal allograft failure has not been well studied. METHODS: A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996. The mortality, wait-listing, and repeat transplantation rates were assessed. The mortality risks associated with repeat transplantation were estimated with a time-dependent survival model. RESULTS: In total, 34.5% (n=6,631) of patients died during follow-up. Of these deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients. Before repeat transplantation, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal disease, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Americans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other races, respectively (P<0.0001 each). Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. CONCLUSIONS: The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.
Authors: J R Cassuto; P P Reese; S Sonnad; R D Bloom; M H Levine; K M Olthoff; A Shaked; A Naji; P Abt Journal: Am J Transplant Date: 2010-11 Impact factor: 8.086
Authors: Samer M T Al-Geizawi; Rajinder P Singh; Jack M Zuckerman; Jay A Requarth; Alan C Farney; Jeffrey Rogers; Jacob Taussig; Giuseppe Orlando; Robert J Stratta Journal: J Nephrol Date: 2014-09-30 Impact factor: 3.902
Authors: Maarten G Snoeijs; Douglas E Schaubel; Ronald Hené; Andries J Hoitsma; Mirza M Idu; Jan N Ijzermans; Rutger J Ploeg; Jan Ringers; Maarten H Christiaans; Wim A Buurman; L W Ernest van Heurn Journal: J Am Soc Nephrol Date: 2010-05-20 Impact factor: 10.121
Authors: Muhammad A Mujtaba; Tim E Taber; William C Goggins; Muhammad S Yaqub; Dennis P Mishler; Martin L Milgrom; Jonathan A Fridell; Andrew Lobashevsky; John A Powelson; Asif A Sharfuddin Journal: Clin J Am Soc Nephrol Date: 2010-11-04 Impact factor: 8.237
Authors: Jeffrey Perl; Jinyao Zhang; Brenda Gillespie; Bjorn Wikström; Joan Fort; Takeshi Hasegawa; Douglas S Fuller; Ronald L Pisoni; Bruce M Robinson; Francesca Tentori Journal: Nephrol Dial Transplant Date: 2012-09-30 Impact factor: 5.992