Han Sang Hyup, Go Jin, Park Sun Cheol, Yun Sang Seob
Division of Vascular and Transplantation Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea.
Division of Vascular and Transplantation Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea.
Transplant Proc. 2019 Oct;51(8):2582-2586. doi: 10.1016/j.transproceed.2019.03.070. Epub 2019 Aug 29.
Advances in renal transplantation have improved graft survival. However, many patients experience graft failure due to chronic renal allograft nephropathy. Although renal retransplantation is increasingly performed, its outcome is controversial. The aim of this study was to evaluate outcomes of renal retransplantation compared with those of first renal transplantation.
From March 1969 to August 2018, there were 3000 cases of renal transplantation performed at Seoul St. Mary's Hospital, Korea. Because the number of third renal transplantation was too small, only first and second renal transplantation groups were compared using propensity score matching. Outcomes of the third renal transplantation were then added. Graft survival rates were determined using Kaplan-Meier survival curves and assessed for significance using log-rank test.
Five- and 10-year patient-graft survival rates for the first renal transplantation were 82.6% and 72.8%, respectively. Those for the second renal transplantation were 78.4% and 73.9%, respectively (P = .588). Five- and 10-year patient survival rates were 91.2% and 85.1%, respectively, for the first renal transplantation. These were 87.8% and 85.5%, respectively, for the second renal transplantation (P = .684). Five- and 10-year death-censored graft survival rates were 88.8% and 80.6%, respectively, for the first renal transplantation. These were 84.6% and 80.5%, respectively, for the second renal transplantation (P = .564).
This study showed that graft survival of second renal transplantation was not significantly different from that of first renal transplantation. Therefore, renal retransplantation might be a reasonable option for patients who lost the first renal graft.
肾移植技术的进步提高了移植物存活率。然而，许多患者因慢性同种异体肾移植肾病而出现移植失败。尽管肾再次移植越来越普遍，但其结果仍存在争议。本研究的目的是评估肾再次移植与首次肾移植的结果。
1969年3月至2018年8月，韩国首尔圣玛丽医院共进行了3000例肾移植手术。由于第三次肾移植的病例数过少，仅使用倾向评分匹配法比较了首次和第二次肾移植组。然后纳入第三次肾移植的结果。使用Kaplan-Meier生存曲线确定移植物存活率，并使用对数秩检验评估其显著性。
首次肾移植的5年和10年患者-移植物存活率分别为82.6%和72.8%。第二次肾移植的相应存活率分别为78.4%和73.9%（P = 0.588）。首次肾移植的5年和10年患者存活率分别为91.2%和85.1%。第二次肾移植的相应存活率分别为87.8%和85.5%（P = 0.684）。首次肾移植的5年和10年死亡截尾移植物存活率分别为88.8%和80.6%。第二次肾移植的相应存活率分别为84.6%和80.5%（P = 0.564）。
本研究表明，第二次肾移植的移植物存活率与首次肾移植无显著差异。因此，对于首次肾移植失败的患者，肾再次移植可能是一个合理的选择。
