TY - JOUR
T1 - Trends in the survival benefit of repeat kidney transplantation over the past 3 decades
AU - Sandal, Shaifali
AU - Ahn, Ji Yoon B.
AU - Chen, Yusi
AU - Massie, Allan B.
AU - Clark-Cutaia, Maya N.
AU - Wu, Wenbo
AU - Cantarovich, Marcelo
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara A.
N1 - Funding Information:
This study was supported by NIH R01DK120518 (McAdams-DeMarco) and K24AI144954 (Segev). Mara McAdams-DeMarco was also supported by K02AG076883 and R01AG055781 from the National Institute on Aging and R01DK114074 from NIDDK. Dr. Sandal is supported by the Chercheur boursier clinicien –Junior 1 award from the Fonds de recherche du Québec–Santé. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, writing, review, or approval of the manuscript.D.L. Segev receives speaking honoraria from Sanofi and Novartis. S. Sandal has received an education grant from Amgen Canada. M.A. McAdams-DeMarco received speaking honoraria from Chiesi. The other authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. The results presented in this paper have not been published previously in whole or part, except in the abstract format.
Funding Information:
This study was supported by NIH R01DK120518 (McAdams-DeMarco) and K24AI144954 (Segev). Mara McAdams-DeMarco was also supported by K02AG076883 and R01AG055781 from the National Institute on Aging and R01DK114074 from NIDDK . Dr. Sandal is supported by the Chercheur boursier clinicien –Junior 1 award from the Fonds de recherche du Québec–Santé. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, writing, review, or approval of the manuscript.
Publisher Copyright:
© 2023 American Society of Transplantation & American Society of Transplant Surgeons
PY - 2023/5
Y1 - 2023/5
N2 - Repeat kidney transplantation (re-KT) is the preferred treatment for patients with graft failure. Changing allocation policies, widening the risk profile of recipients, and improving dialysis care may have altered the survival benefit of a re-KT. We characterized trends in re-KT survival benefit over 3 decades and tested whether it differed by age, race/ethnicity, sex, and panel reactive assay (PRA). By using the Scientific Registry of Transplant Recipient data, we identified 25 419 patients who underwent a re-KT from 1990 to 2019 and 25 419 waitlisted counterfactuals from the same year with the same waitlisted time following graft failure. In the adjusted analysis, a re-KT was associated with a lower risk of death (adjusted hazard ratio [aHR] = 0.63; 95% confidence interval [CI], 0.61-0.65). By using the 1990-1994 era as a reference (aHR = 0.77; 95% CI, 0.69-0.85), incremental improvements in the survival benefit were noted (1995-1999: aHR = 0.72; 95% CI, 0.67-0.78: 2000-2004: aHR = 0.59; 95% CI, 0.55-0.63: 2005-2009: aHR = 0.59; 95% CI, 0.56-0.63: 2010-2014: aHR = 0.57; 95% CI, 0.53-0.62: 2015-2019: aHR = 0.64; 95% CI, 0.57-0.73). The survival benefit of a re-KT was noted in both younger (age = 18-64 years: aHR = 0.63; 95% CI, 0.61-0.65) and older patients (age ≥65 years: aHR = 0.66; 95% CI, 0.58-0.74; Pinteraction = .45). Patients of all races/ethnicities demonstrated similar benefits with a re-KT. However, it varied by the sex of the recipient (female patients: aHR = 0.60; 95% CI, 0.56-0.63: male patients: aHR = 0.66; 95% CI, 0.63-0.68; Pinteraction = .004) and PRA (0-20: aHR = 0.69; 95% CI, 0.65-0.74: 21-80: aHR = 0.61; 95% CI, 0.57-0.66; Pinteraction = .02; >80: aHR = 0.57; 95% CI, 0.53-0.61; Pinteraction< .001). Our findings support the continued practice of a re-KT and efforts to overcome the medical, immunologic, and surgical challenges of a re-KT.
AB - Repeat kidney transplantation (re-KT) is the preferred treatment for patients with graft failure. Changing allocation policies, widening the risk profile of recipients, and improving dialysis care may have altered the survival benefit of a re-KT. We characterized trends in re-KT survival benefit over 3 decades and tested whether it differed by age, race/ethnicity, sex, and panel reactive assay (PRA). By using the Scientific Registry of Transplant Recipient data, we identified 25 419 patients who underwent a re-KT from 1990 to 2019 and 25 419 waitlisted counterfactuals from the same year with the same waitlisted time following graft failure. In the adjusted analysis, a re-KT was associated with a lower risk of death (adjusted hazard ratio [aHR] = 0.63; 95% confidence interval [CI], 0.61-0.65). By using the 1990-1994 era as a reference (aHR = 0.77; 95% CI, 0.69-0.85), incremental improvements in the survival benefit were noted (1995-1999: aHR = 0.72; 95% CI, 0.67-0.78: 2000-2004: aHR = 0.59; 95% CI, 0.55-0.63: 2005-2009: aHR = 0.59; 95% CI, 0.56-0.63: 2010-2014: aHR = 0.57; 95% CI, 0.53-0.62: 2015-2019: aHR = 0.64; 95% CI, 0.57-0.73). The survival benefit of a re-KT was noted in both younger (age = 18-64 years: aHR = 0.63; 95% CI, 0.61-0.65) and older patients (age ≥65 years: aHR = 0.66; 95% CI, 0.58-0.74; Pinteraction = .45). Patients of all races/ethnicities demonstrated similar benefits with a re-KT. However, it varied by the sex of the recipient (female patients: aHR = 0.60; 95% CI, 0.56-0.63: male patients: aHR = 0.66; 95% CI, 0.63-0.68; Pinteraction = .004) and PRA (0-20: aHR = 0.69; 95% CI, 0.65-0.74: 21-80: aHR = 0.61; 95% CI, 0.57-0.66; Pinteraction = .02; >80: aHR = 0.57; 95% CI, 0.53-0.61; Pinteraction< .001). Our findings support the continued practice of a re-KT and efforts to overcome the medical, immunologic, and surgical challenges of a re-KT.
KW - era analysis
KW - older adults
KW - repeat transplantation
KW - survival
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U2 - 10.1016/j.ajt.2023.01.008
DO - 10.1016/j.ajt.2023.01.008
M3 - Article
C2 - 36731783
AN - SCOPUS:85153252182
SN - 1600-6135
VL - 23
SP - 666
EP - 672
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -