Preemptive second kidney transplantation is associated with better graft survival compared with non‐preemptive second transplantation: a multicenter French 2000–2014 cohort study. (20th December 2017)

• Record Type: Journal Article
• Authors: Girerd, Sophie; Girerd, Nicolas; Duarte, Kevin; Giral, Magali; Legendre, Christophe; Mourad, Georges; Garrigue, Valérie; Morelon, Emmanuel; Buron, Fanny; Kamar, Nassim; Del Bello, Arnaud; Ladrière, Marc; Kessler, Michèle; Frimat, Luc
• Is Part Of: Transplant international. Volume 31:Number 4(2018)
• Page Start: 408
• Page End: 423
• Publication Date: 2017-12-20
• Subjects: kidney transplantation -- living donor -- preemptive -- retransplantation -- second transplantation -- survival; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13105
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: The impact of preemptive second kidney transplantation (2KT) on graft and patient survival is poorly established. The association between preemptive 2KT (p2KT, N = 93) and outcomes was estimated in a multicenter French cohort of 2KT ( N = 1314) recipients using propensity score methods. During the follow‐up, there were 274 returns to dialysis and 134 deaths. p2KT was associated with lower death‐censored graft loss (HR = 0.39 [0.18–0.88], P = 0.024) and graft failure from any cause including death (HR = 0.42 [0.22–0.80], P = 0.008). Similar associations were observed for death with a functioning graft, although not reaching statistical significance (HR = 0.47 [0.17–1.26], P = 0.13). There was a significant interaction between donor type and p2KT ( P for interaction = 0.016). Indeed, p2KT was not significantly associated with the risk of graft failure from any cause including death in living donor 2KT ( P = 0.39), whereas the association was substantial in the deceased donor subset (HR = 0.30 [0.14–0.64], P = 0.002). Of note, the adjusted graft survival of p2KT with deceased donor paralleled that of 2KT with living donor, either preemptive or not (93.8% vs. 88.6% at 4 years and 76.1% vs. 70.5% at 8 years, P = 0.13). This large French multicenter study analyzed using propensity scores suggests that p2KT is associated with better graft prognosis.