Kidney Week

Abstract: PO2056

The Survival Benefit of Re-Kidney Transplantation in Older and Younger Patients with Graft Failure

Session Information

• Transplantation: Clinical - Allocation, Evaluation, Prognosis, and Viral Onslaughts
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Ahn, JiYoon B., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

JiYoon B. Ahn

• Sandal, Shaifali, McGill University Health Centre, Montreal, Quebec, Canada

Shaifali Sandal,

• Segev, Dorry L., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Dorry L. Segev,

• McAdams-DeMarco, Mara, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

Group or Team Name

• ERGOT

Background

The survival benefit of re-kidney transplantation (re-KT) has been demonstrated two decades ago in younger patients. The proportion of patients with graft failure is increasing, particularly among those aged≥65. We compared the survival benefit of re-KT by patient age.

Methods

Using data from the Scientific Registry of Transplant Recipients, we identified 42,366 patients who experienced graft failure after their first KT and were listed for re-KT between 1990-2019. We treated re-KT as a time-dependent variable and used Cox regression to compare the risk of mortality between being listed for a re-KT and undergoing re-KT. We used the inverse probability weighting method to account for potential confounding. We also tested whether the risk of mortality differed by patient age at listing (18-64 versus ≥65 years) using a Wald test.

Results

Overall, 42,366 patients were listed for re-KT and 47.5% underwent re-KT by 10/31/2020. The number of patients being listed for re-KT tripled between 1990 and 2019. The mortality rate was 6.6 per 100 person-years among patients being listed and 3.0 per 100 person-years among those retransplanted. Overall, the risk of mortality was lower after re-KT than during listing (adjusted hazard ratio [aHR]=_0.420.43_0.45). However, the association differed by age (P_interaction=0.03), but the survival benefit of retransplant was observed among both younger (aHR=_0.410.42_0.44) and older patients (aHR=_0.430.49_0.55).

Conclusion

Our finding suggests that re-KT is associated with a significant survival benefit in younger and older patients. In addition, long-term outcomes in older re-KT recipients were reported comparable to those in older first KT recipients. Transplant centers should consider expanding re-KT to appropriate older adults.

Funding

• NIDDK Support