Impact of Multiple Kidney Retransplants on Post-Transplant Outcomes in the United States

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-18 DOI:10.1016/j.transproceed.2024.12.016

Charat Thongprayoon , Oscar A. Garcia Valencia , Jing Miao , Iasmina M. Craici , Shennen A. Mao , Michael A. Mao , Supawit Tangpanithandee , Justin H. Pham , Napat Leeaphorn , Wisit Cheungpasitporn

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引用次数: 0

Abstract

Background

Kidney retransplantation offers a valuable treatment option for patients who experience graft failure after their initial transplant. There is an increasing number of patients undergoing multiple retransplants. However, the impact of multiple kidney retransplants on post-transplant outcomes remains unclear. This study aimed to assess the association between the number of kidney retransplants and post-transplant outcomes in kidney retransplant recipients.

Methods

We used the Organ Procurement and Transplantation Network and United Network for Organ Sharing (OPTN/UNOS) database to identify kidney-only retransplant recipients in United States from 2010 through 2019. We categorized kidney retransplant recipients based on their number of kidney retransplant into one and two plus kidney retransplant groups. The association of one vs two plus kidney retransplants with death-censored graft failure and patient death was assessed using Cox proportional hazard analysis, and acute rejection using logistic regression analysis.

Results

Of 17,433 kidney retransplant recipients included in this study, 15,821 (91%) and 1612 (9%) had one and two plus kidney retransplants, respectively. Patients with two plus kidney retransplants were younger, predominantly White, had higher panel reactive antibody (PRA), public insurance, and education, but had less history of diabetes mellitus and total HLA mismatch compared with patients with one kidney retransplant. After adjusting for potential confounders, having two plus kidney retransplants was significantly associated with increased risk of death-censored graft failure (hazard ratio [HR] = 1.20, 95% confidence interval [CI] = 1.02-1.42) and allograft rejection (odds ratio [OR] = 1.30, 95% CI = 1.09-1.54), but it was not significantly associated with patient death.

Conclusions

Patients undergoing multiple kidney retransplants face a higher risk of graft failure and rejection compared with those with a single retransplant. These findings underscore the need for tailored management and monitoring strategies to improve outcomes for patients receiving multiple kidney retransplants.

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在美国，多次肾再移植对移植后结果的影响

背景：肾再移植为初次移植失败的患者提供了一个有价值的治疗选择。越来越多的患者接受多次再移植。然而，多肾再移植对移植后预后的影响尚不清楚。本研究旨在评估肾再移植数量与肾再移植受者移植后预后之间的关系。方法：我们使用器官获取和移植网络和联合器官共享网络（OPTN/UNOS）数据库来识别2010年至2019年美国的仅肾再移植受者。我们根据肾再移植的数量将肾再移植受者分为一组和二组再移植组。使用Cox比例风险分析评估1 + vs 2 +肾再移植与死亡审查移植失败和患者死亡的关系，使用logistic回归分析评估急性排斥反应。结果：在本研究纳入的17433例肾再移植受者中，15821例（91%）和1612例（9%）分别进行了一次肾再移植和两次肾再移植。2 +肾再移植患者较年轻，以白人为主，有较高的整体反应性抗体（PRA），公共保险和教育水平，但与1肾再移植患者相比，糖尿病史和总HLA错配较少。在校正了潜在的混杂因素后，两次肾再移植与死亡审查移植失败（风险比[HR] = 1.20, 95%可信区间[CI] = 1.02-1.42）和同种异体移植排斥（优势比[OR] = 1.30, 95% CI = 1.09-1.54）的风险增加显著相关，但与患者死亡无显著相关。结论：与单次肾再移植患者相比，多次肾再移植患者面临更高的移植衰竭和排斥风险。这些发现强调了需要量身定制的管理和监测策略来改善接受多肾再移植的患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.