Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
Clin Transplant. 2020 Aug;34(8):e13907. doi: 10.1111/ctr.13907. Epub 2020 Jun 14.
Few studies investigate significant perioperative predictors for long-term renal allograft survival after second kidney transplant (SKT). We compared long-term survival following SKT with primary kidney transplant and determined predictors of renal allograft failure after SKT.
Outcomes of all primary or second kidney transplant recipients at a national kidney transplant center between 1993 and 2017 were reviewed. The primary outcomes measurements were renal allograft survival for both first and second kidney transplants. Secondary outcome measurements were incidence of delayed graft function (DGF), incidence of acute rejection (AR), and predictors for renal allograft survival in SKT recipients.
In total, there were 392 SKTs and 2748 primary kidney transplants performed between 1993 and 2017. The 1-, 5-, and 10-year death-censored graft survival for deceased-donor recipients was 95.3%, 88.7%, and 78.2% for primary kidney transplant and 94.9%, 87.1%, and 74.9% for SKT (P = .0288). Survival of primary renal allograft <6 years (HR 0.6, P = .017), AR episodes (HR 1.6, P = .031), DGF (HR 2.0, P = .005), and HLA-DR MM (HR 1.7, P = .018) was independent predictors of long-term renal allograft failure after SKT.
These findings may provide important information on long-term survival outcomes after SKT and for identifying patients at risk for long-term renal allograft failure after SKT.
很少有研究调查第二次肾移植（SKT）后长期肾移植存活的重要围手术期预测因素。我们比较了 SKT 后与初次肾移植的长期生存情况，并确定了 SKT 后肾移植失败的预测因素。
回顾了 1993 年至 2017 年间在国家肾移植中心进行的所有初次或第二次肾移植受者的结局。主要结局测量指标是首次和第二次肾移植的肾移植存活率。次要结局测量指标是延迟移植物功能障碍（DGF）的发生率、急性排斥反应（AR）的发生率以及 SKT 受者肾移植存活的预测因素。
1993 年至 2017 年间共进行了 392 例 SKT 和 2748 例初次肾移植。供体死亡受者的 1、5 和 10 年死亡风险调整移植物存活率分别为初次肾移植的 95.3%、88.7%和 78.2%和 SKT 的 94.9%、87.1%和 74.9%（P=.0288）。初次肾移植存活时间<6 年（HR 0.6，P=.017）、AR 发作（HR 1.6，P=.031）、DGF（HR 2.0，P=.005）和 HLA-DR MM（HR 1.7，P=.018）是 SKT 后长期肾移植失败的独立预测因素。
这些发现可能为 SKT 后长期生存结果提供重要信息，并为识别 SKT 后长期肾移植失败风险患者提供信息。
