1. Retransplant patients that experienced acute rejection, hospitalization, or delayed graft function after their first kidney transplant were more likely to experience such negative outcomes post-retransplant.
2. Relisting of patients was found to be statistically dependent on outcomes within the first year of the primary transplant, including GFR and hospitalization.
Evidence Rating Level: 2 (Good)
Study Rundown: As kidney transplant waitlists continue to grow, significant focus has been assigned to understanding risk factors that may be used to identify strong or weak transplant candidates. In particular, this study examined factors surrounding initial kidney transplants for potential predictive qualities to aid clinicians in choosing whether to relist patients for retransplants. Primary transplant outcomes used as metrics of evaluation included acute rejection, hospitalization, delayed graft function (DGF), glomerular filtration rate (GFR) and graft survival. A number of such outcome metrics as well as primary donor and recipient characteristics (including age, recipient race, and donor type) were found to have predictive characteristics in determining similar outcomes in retransplants. Acute rejection, hospitalization, and delayed graft function in primary transplants were predictive of increased likelihood of the same outcome experienced in retransplant. Higher GFR post primary transplant was associated with higher GFR after retransplant and a longer graft survival in the primary transplant was also correlated with longer graft survival following retransplant. The findings of this study suggest both positive and negative outcomes experienced after a primary transplant may be used as predictors of a similar outcome occurring in retransplant. One key limitation of this study and others of similar design is the inability to capture all potential influences of the failure or success of a primary or secondary transplant. Another limitation of this study is the use of incomplete databases and patient histories, which allows for potential inaccuracies or biases in the developed models.
Relevant Reading: Risks and benefits of preemptive second kidney transplantation
In-Depth: [retrospective cohort]: This study examined transplant outcomes in 11,698 adult patients that underwent a primary kidney transplant between the years of 1987 and 2011 and a repeat transplant between the years of 2002 and 2011. Patient data was compiled primarily from the national Scientific Registry of Transplant Recipients database, as well as from Social Security and the Centers for Medicare and Medicaid Services. Acute rejection within one year of the primary transplant resulted in a 26% increased likelihood of acute rejection within one year of the secondary transplant (adjusted odds ratio (AOR) and 95% confidence interval (CI) = 1.26 (1.07-1.48), p = 0.0053). Delayed graft function (DGF) after initial transplant was correlated with a 35% higher risk of DGF after retransplant (AOR and 95% CI = 1.35 (1.18-1.54), p = 0.0050). Shorter graft survival in the primary transplant was associated with increased acute rejection and hospitalization post-retransplant. Longer graft survival was associated with higher retransplant GFR and decreased of retransplant DGF. Longer graft survival time (³79 months) and higher GFR (³60 ml/min/1.73m2) after a primary transplant were both associated with increased graft survival time after the secondary transplant. Relisting of patients was found to be statistically dependent on outcomes within the first year of the primary transplant, including GFR and hospitalization.
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