Abstract: SA-PO025
The Risk of Renal Re-Transplantation
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Schwarz, Anke, Hannover Medical School, Hannover, Germany
- Framke, Theodor, Hannover Medical School, Hannover, Germany
- Haller, Hermann G., Hannover Medical School, Hannover, Germany
Background
Renal transplant programs comprise around 15% of re-transplantations. We aimed to know if renal re-transplantation (Tx2) has a higher risk than first transplantation (Tx1), and if so, to analyze the reasons for it.
Methods
This is a retrospective monocenter study by comparing graft and patient survival of all 162 Tx2 patients transplanted 2000 to 2009 (study group) with 162 Tx1 patients matched for age (± 10 years), gender, date of transplantation (± 18 months), and the kind of kidney donation (control group). We looked for differences in clinical parameters with a possible influence on graft and patient survival (observation time 8 to 17 years).
Results
Graft and patient survival of TX2 was inferior to that of TX1 patients (p=0.0011 resp p=0.0477, test for paired data). Group TX2 had a longer dialysis treatment than TX1 (113.0±52.5 vs 65.6±33.9 months; p<0.0001); more often HLA mismatches (MM) (2.54±1.75 vs 2.08±1.65, p=0.0129) and preformed panel reactive HLA-antibodies (PRA) >30% (15.4% vs 1.9%, p=0.0001); and more often induction therapy by thymoglobulin instead of IL-2R antibody (59.9% vs 1.9%, p<0.0001). The number of patients with rejection (39.57% vs 36.4%) and of rejections per patient (0.58±0.92 vs 0.56±0.87) were not different; however, graft failure by acute and chronic rejection was more frequent in the Tx2 group (32.22% vs 21.21%, p=0.0137). The number of patients with severe infections threatening life and/or graft function was not different (41.36% vs 39.5%); however, death by severe infection was more frequent in group Tx2 (0.0411). Testing several variables by Kaplan-Meier curves, Tx2 show an inferior graft survival than Tx1 patients with a higher number of HLA-MM (logrank p=0.0137), with humoral rejection (logrank p=0.0037), and have a higher mortality with several concomitant diseases, (logrank p<0.0001), especially cardiovascular disease (logrank p<0.0001), and severe infection (logrank p=0.0001).
Conclusion
Tx2 patients have several reasons for an inferior graft and patient survival compared to Tx1 patients:
a) Immunologic reasons (more often HLA MM and high PRA, more often graft failure by rejection);
b) higher mortality by concomitant diseases, especially cardiovascular disease and infection;
c) less capacity to adapt to immunologic and infectious problems and failure to cope with them.