Trends in the survival benefit of repeat kidney transplantation over the past 3 decades

Shaifali Sandal; JiYoon B Ahn; Yusi Chen; Allan B Massie; Maya N Clark-Cutaia; Wenbo Wu; Marcelo Cantarovich; Dorry L Segev; Mara A McAdams-DeMarco

doi:10.1016/j.ajt.2023.01.008

Trends in the survival benefit of repeat kidney transplantation over the past 3 decades

Am J Transplant. 2023 May;23(5):666-672. doi: 10.1016/j.ajt.2023.01.008. Epub 2023 Jan 31.

Authors

Shaifali Sandal¹, JiYoon B Ahn², Yusi Chen³, Allan B Massie³, Maya N Clark-Cutaia⁴, Wenbo Wu⁵, Marcelo Cantarovich⁶, Dorry L Segev³, Mara A McAdams-DeMarco⁷

Affiliations

¹ Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: shaifali.sandal@mcgill.ca.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York, USA.
⁴ Department of Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA.
⁵ Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
⁶ Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York, USA; Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.

Abstract

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; P_interaction = .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; P_interaction = .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; P_interaction = .02; >80: aHR = 0.57; 95% CI, 0.53-0.61; P_interaction< .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.

Keywords: era analysis; older adults; repeat transplantation; survival.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Female
Graft Survival
Humans
Kidney Failure, Chronic* / complications
Kidney Transplantation*
Male
Middle Aged
Registries
Risk
Risk Factors
Young Adult

Abstract

Publication types

MeSH terms

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