Gately Ryan, Wong Germaine, Teixeira-Pinto Armando, Pilmore Helen, Hawley Carmel, Campbell Scott, Mulley William, Lim Wai H
Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Transplant Direct. 2024 Oct 18;10(11):e1717. doi: 10.1097/TXD.0000000000001717. eCollection 2024 Nov.
Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN.
Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease.
Of 3276 patients who received a second kidney transplant, 179 (5%) lost their first allograft from recurrent GN. Between 2006 and 2021, 1524 patients with failed first allografts (6% with recurrent GN, 45% with primary GN but no disease recurrence) were relisted for transplantation. Compared with patients without primary GN, the adjusted hazard ratios (95% confidence intervals) for relisting in patients with primary GN, with and without disease recurrence, were 1.09 (0.88-1.34) and 1.16 (1.05-1.29), respectively. The respective adjusted hazard ratios for allograft loss after repeat transplantation were 0.77 (0.59-1) and 1.02 (0.9-1.16). Of the 81 patients who received a second allograft after losing their first allograft to GN recurrence, 18 patients (22%) also lost their second allograft because of recurrent GN.
Patients with prior allograft loss from GN recurrence were not disadvantaged, with comparable waitlist potential and allograft outcome after repeat transplantation. However, >20% of those with prior allograft loss from disease recurrence also lost their second allografts from recurrent disease.
当肾小球肾炎（GN）是肾衰竭的主要原因时，复发性肾小球肾炎是移植后同种异体肾移植丢失的重要原因。同种异体肾移植因复发性疾病丢失后再次移植需要谨慎考虑。我们旨在确定既往同种异体肾移植因复发性GN丢失的受者再次移植后重新列入等待名单的概率和同种异体肾移植丢失的风险。
利用澳大利亚和新西兰透析与移植登记处的数据以及多变量Cox模型，我们比较了既往同种异体肾移植因复发性疾病丢失和未丢失的患者二次移植后列入等待名单的概率和同种异体肾移植丢失情况。
在接受第二次肾移植的3276例患者中，179例（5%）因复发性GN失去了首次同种异体肾移植。2006年至2021年期间，1524例首次同种异体肾移植失败的患者（6%为复发性GN，45%为原发性GN但无疾病复发）重新列入移植等待名单。与无原发性GN的患者相比，原发性GN患者无论有无疾病复发，重新列入等待名单的调整后风险比（95%置信区间）分别为1.09（0.88 - 1.34）和1.16（1.05 - 1.29）。再次移植后同种异体肾移植丢失的相应调整后风险比分别为0.77（0.59 - 1）和1.02（0.9 - 1.16）。在81例因GN复发失去首次同种异体肾移植后接受第二次同种异体肾移植的患者中，18例（22%）也因复发性GN失去了第二次同种异体肾移植。
既往同种异体肾移植因GN复发丢失的患者并无劣势，再次移植后的等待名单潜力和同种异体肾移植结局相当。然而，既往因疾病复发失去同种异体肾移植的患者中，超过20%的人也因复发性疾病失去了第二次同种异体肾移植。
