Early second kidney transplantation benefits patients with failing first allograft
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Early second kidney transplantations correlate with patient survival compared with those waitlisted and on dialysis, according to data published in the Clinical Journal of the American Society of Nephrology.
However, the survival difference “diminishes” as patients remain on the waitlist.
“At the moment, waiting time for kidney transplant differs between countries and depends on patient-related comorbidities and histocompatibility factors, such as the degree of human leukocyte antigen (HLA) sensitization, HLA genotype and ABO blood group,” Rainer Oberbauer, MD, PhD, from the department of nephrology and dialysis in Internal Medicine III at the Medical University of Vienna, and colleagues wrote.
In a retrospective study, researchers used observational data from the Austrian Dialysis and Transplant Registry to assess the way waiting time affects the survival difference of a second kidney transplant patient compared with those waitlisted on dialysis. Researchers followed 2,346 adult participants with a failed first graft who were waitlisted for a second transplant between Jan. 1, 1980, and Aug. 31, 2019, until death, loss to follow-up or end of the observation period.
“We used the state-of-the-art causal inference methodology of target trial emulation, which comprised the development of a protocol for a hypothetical randomized trial to answer the research questions of interest, and subsequently using the registry data to mimic the target trial, adhering to the identification principles of causal inference to mitigate biases arising in analyses of observational data,” Oberbauer and colleagues wrote.
Mortality served as the primary outcome of this study.
Of the 2,346 participants, 1,869 of the waitlisted patients received retransplants and 966 died (262 died while on the waiting list; 704 died after retransplantation). Overall, patients who received a second kidney transplantation gained 5.8 life months by the 10-year follow-up compared with those who remained on the waitlist. However, the survival difference lessened in patients with longer waiting times after loss of the first allograft. Those who waited less than 1 year gained 8 life months, whereas those who waited at least 8 years gained 0.1 life months after the second transplantation.
“We conclude that early retransplantation for eligible individuals provides an effective treatment strategy to improve overall survival in patients with a failing first allograft. This survival difference may diminish in patients eligible for transplantation with a waiting time for retransplantation longer than 3 years,” Oberbauer and colleagues wrote. “Our findings could provide further perspectives on allocation priorities as donor organs remain a limited good.”
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