Abstract: FR-PO1194
Impact of First Kidney Transplant Type on the Outcomes of a Subsequent Transplant
Session Information
- Transplantation: Clinical - Immunosuppression, Adherence, Outcomes
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- McGill, Rita L., University of Chicago, Chicago, Illinois, United States
- Shah, Pratik B., University of Chicago, Chicago, Illinois, United States
- Chopra, Bhavna, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Cunningham, Patrick, University of Chicago, Chicago, Illinois, United States
- Josephson, Michelle A., University of Chicago, Chicago, Illinois, United States
Background
Many patients with kidney failure will require more than one kidney transplant during their life time. It will be useful to know the impact of the type of ( living vs. deceased donor) first transplant on the outcomes of a subsequent transplant as well as cumulative graft survivals between first (G1) and second (G2) espeically in patients with limited living donor options.
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Methods
Using OPTN/UNOS database, we identified patients who underwent a second kidney transplantation between 1996 and 2016. Patients were then stratified into 4 groups based on the sequence of the transplant type as follows: living donor (LD) first, LD second (n=4402); deceased donor (DD) first, LD second (n=2460); LD first, DD second (n=5723); DD first, DD second (n=11411). Using a Cox model, graft outcomes were compared for the second transplant (G2) in all 4 transplant sequences. Subsequently a cumulative combined allograft failure risk (G1 + G2) was also calculated.
Results
Survival plots for G2 are shown in figure 1. Adjusted graft failure risks for G2 along with G1+G2 are shown in the table.
Conclusion
We observed reduced cumulative graft failure risk associated with DD followed by LD sequence compared to LD followed by DD sequence. This interesting observation could be related to the disproportionately negative impact of second DD transplant on overall outcomes.
Graft Failure by Donor Type Sequence
| 1st - 2nd | Graft 2 Failure | G1 + G2 Failure |
| LD - LD | Ref | Ref |
| DD - LD | 1.25 (1.13, 1.38) | 1.43 (1.30, 1.58) |
| LD - DD | 1.64 (1.51, 1.78) | 2.10 (1.94, 2.28) |
| DD - DD | 1.91 (1.77, 2.05) | 2.54 (2.36, 2.73) |