Muramatsu Masaki, Hyodo Yoji, Sheaff Michael, Gupta Arun, Ashman Neil, Aikawa Atsushi, Yaqoob Magdi, Puliatti Carmelo
From the Renal Medicine and Transplantation Department, The Royal London Hospital, London, United Kingdom; and the Nephrology Department, Toho University Faculty of Medicine, Tokyo, Japan.
Exp Clin Transplant. 2018 Jun;16(3):259-265. doi: 10.6002/ect.2018.0046. Epub 2018 Apr 20.
The impact of allograft nephrectomy on the outcome of a subsequent renal transplant is unclear. This study was conducted to assess the effects of the first allograft nephrectomy on outcomes of a second transplant.
This study included 118 patients who received a second transplant between 1994 and 2015. Before the second transplant, 59 patients did not undergo a first allograft nephrectomy (group A). Group B comprised 59 patients who had undergone a first allograft nephrectomy. We compared sensitization, acute rejection, and survival of the second graft between groups. The risk factors of a second graft loss were assessed.
The first graft survival was significantly longer in group A than in group B (100.6 vs 3.7 months; P < .001). Prevalence of preformed donor-specific antibodies before the second allograft was similar between both groups (28.8% vs 39.0% for group A vs group B; P = .243). Numerically higher acute rejection rates occurred in group B than in group A (23.7% vs 15.3%; P = .245). In group A, graft survival rates at 1, 3, and 5 years were 93.0%, 87.0%, and 82.3% and were significantly higher than for group B (76.7%, 69.1%, and 62.5%; P ⟨ .05). On multivariate analysis, survival of the second graft was affected by acute rejection (hazard ratio = 2.24; 95% confidence interval, 1.10-4.45; P = .027) and the interval from first graft loss to second transplant (hazard ratio = 1.11; 95% confidence interval, 1.02-1.19; P = .008).
A first allograft nephrectomy was associated with inferior second graft survival. We recommend that recipients of second transplants should be considered as high risk if they had undergone prior allograft nephrectomy.
同种异体肾切除术对后续肾移植结局的影响尚不清楚。本研究旨在评估首次同种异体肾切除术对二次移植结局的影响。
本研究纳入了1994年至2015年间接受二次移植的118例患者。在二次移植前，59例患者未接受首次同种异体肾切除术（A组）。B组由59例接受过首次同种异体肾切除术的患者组成。我们比较了两组之间的致敏情况、急性排斥反应和二次移植肾的存活率。评估了二次移植肾丢失的危险因素。
A组首次移植肾的存活时间显著长于B组（100.6个月对3.7个月；P <.001）。二次同种异体移植前预先形成的供体特异性抗体的发生率在两组之间相似（A组对B组分别为28.8%对39.0%；P =.243）。B组的急性排斥反应发生率在数值上高于A组（23.7%对15.3%；P =.245）。在A组中，1年、3年和5年的移植肾存活率分别为93.0%、87.0%和82.3%，显著高于B组（76.7%、69.1%和62.5%；P <.05）。多因素分析显示，二次移植肾的存活受急性排斥反应（风险比 = 2.24；95%置信区间，1.10 - 4.45；P =.027）和从首次移植肾失活到二次移植的间隔时间（风险比 = 1.11；95%置信区间，1.02 - 1.19；P =.008）的影响。
首次同种异体肾切除术与二次移植肾较差的存活率相关。我们建议，如果二次移植受者曾接受过同种异体肾切除术，应将其视为高风险患者。
