Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, REDinREN (RD16/0009/0006), Malaga, Spain.
Clinic Biostatistic Unit, Hospital Ramón y Cajal IRYCIS, CIBERESP, Universidad Autónoma, Madrid, Spain.
PLoS One. 2018 Mar 7;13(3):e0193091. doi: 10.1371/journal.pone.0193091. eCollection 2018.
Whether patients waitlisted for a second transplant after failure of a previous kidney graft have higher mortality than transplant-näive waitlisted patients is uncertain.
We assessed the relationship between a failed transplant and mortality in 3851 adult KT candidates, listed between 1984-2012, using a competing risk analysis in the total population and in a propensity score-matched cohort. Mortality was also modeled by inverse probability weighting (IPTW) competing risk regression.
At waitlist entry 225 (5.8%) patients had experienced transplant failure. All-cause mortality was higher in the post-graft failure group (16% vs. 11%; P = 0.033). Most deaths occurred within three years after listing. Cardiovascular disease was the leading cause of death (25.3%), followed by infections (19.3%). Multivariate competing risk regression showed that prior transplant failure was associated with a 1.5-fold increased risk of mortality (95% confidence interval [CI], 1.01-2.2). After propensity score matching (1:5), the competing risk regression model revealed a subhazard ratio (SHR) of 1.6 (95% CI, 1.01-2.5). A similar mortality risk was observed after the IPTW analysis (SHR, 1.7; 95% CI, 1.1-2.6).
Previous transplant failure is associated with increased mortality among KT candidates after relisting. This information is important in daily clinical practice when assessing relisted patients for a retransplant.
在先前的肾移植失败后等待再次移植的患者的死亡率是否高于未接受过移植的等待移植患者尚不确定。
我们使用全人群和倾向评分匹配队列中的竞争风险分析评估了 1984 年至 2012 年间登记的 3851 名成人肾移植候选者中先前移植失败与死亡率之间的关系。通过逆概率加权（IPTW）竞争风险回归也对死亡率进行了建模。
在等待名单进入时，有 225 名（5.8%）患者经历了移植失败。在移植后失败组中，全因死亡率更高（16% vs. 11%；P = 0.033）。大多数死亡发生在列入名单后的三年内。心血管疾病是死亡的主要原因（25.3%），其次是感染（19.3%）。多变量竞争风险回归显示，先前的移植失败与死亡率增加 1.5 倍相关（95%置信区间 [CI]，1.01-2.2）。在倾向评分匹配（1:5）后，竞争风险回归模型显示亚风险比（SHR）为 1.6（95% CI，1.01-2.5）。在 IPTW 分析后也观察到了类似的死亡率风险（SHR，1.7；95% CI，1.1-2.6）。
在重新列入名单后，先前的移植失败与肾移植候选者的死亡率增加相关。在评估重新移植的重新列入患者时，此信息在日常临床实践中很重要。
