Thongprayoon Charat, Garcia Valencia Oscar A, Miao Jing, Craici Iasmina M, Mao Shennen A, Mao Michael A, Tangpanithandee Supawit, Pham Justin H, Leeaphorn Napat, Cheungpasitporn Wisit
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Transplant Proc. 2025 Mar;57(2):214-222. doi: 10.1016/j.transproceed.2024.12.016. Epub 2025 Jan 18.
Kidney retransplantation offers a valuable treatment option for patients who experience graft failure after their initial transplant. There is an increasing number of patients undergoing multiple retransplants. However, the impact of multiple kidney retransplants on post-transplant outcomes remains unclear. This study aimed to assess the association between the number of kidney retransplants and post-transplant outcomes in kidney retransplant recipients.
We used the Organ Procurement and Transplantation Network and United Network for Organ Sharing (OPTN/UNOS) database to identify kidney-only retransplant recipients in United States from 2010 through 2019. We categorized kidney retransplant recipients based on their number of kidney retransplant into one and two plus kidney retransplant groups. The association of one vs two plus kidney retransplants with death-censored graft failure and patient death was assessed using Cox proportional hazard analysis, and acute rejection using logistic regression analysis.
Of 17,433 kidney retransplant recipients included in this study, 15,821 (91%) and 1612 (9%) had one and two plus kidney retransplants, respectively. Patients with two plus kidney retransplants were younger, predominantly White, had higher panel reactive antibody (PRA), public insurance, and education, but had less history of diabetes mellitus and total HLA mismatch compared with patients with one kidney retransplant. After adjusting for potential confounders, having two plus kidney retransplants was significantly associated with increased risk of death-censored graft failure (hazard ratio [HR] = 1.20, 95% confidence interval [CI] = 1.02-1.42) and allograft rejection (odds ratio [OR] = 1.30, 95% CI = 1.09-1.54), but it was not significantly associated with patient death.
Patients undergoing multiple kidney retransplants face a higher risk of graft failure and rejection compared with those with a single retransplant. These findings underscore the need for tailored management and monitoring strategies to improve outcomes for patients receiving multiple kidney retransplants.
肾脏再次移植为初次移植后出现移植物功能衰竭的患者提供了一种有价值的治疗选择。接受多次再次移植的患者数量在不断增加。然而，多次肾脏再次移植对移植后结局的影响仍不清楚。本研究旨在评估肾脏再次移植受者的肾脏再次移植次数与移植后结局之间的关联。
我们使用器官获取与移植网络及器官共享联合网络（OPTN/UNOS）数据库，确定2010年至2019年美国仅接受肾脏再次移植的受者。我们根据肾脏再次移植次数将肾脏再次移植受者分为单次肾脏再次移植组和两次及以上肾脏再次移植组。使用Cox比例风险分析评估单次与两次及以上肾脏再次移植与死亡删失的移植物功能衰竭和患者死亡之间的关联，使用逻辑回归分析评估急性排斥反应。
本研究纳入的17433例肾脏再次移植受者中，分别有15821例（91%）和1612例（9%）接受了单次和两次及以上肾脏再次移植。与单次肾脏再次移植患者相比，两次及以上肾脏再次移植患者更年轻，主要为白人，群体反应性抗体（PRA）更高，有公共保险且受教育程度更高，但糖尿病病史和总HLA错配更少。在对潜在混杂因素进行调整后，两次及以上肾脏再次移植与死亡删失的移植物功能衰竭风险增加（风险比[HR]=1.20，95%置信区间[CI]=1.02-1.42）和同种异体移植物排斥反应（优势比[OR]=1.30，95%CI=1.09-1.54）显著相关，但与患者死亡无显著关联。
与单次再次移植患者相比，接受多次肾脏再次移植的患者面临更高的移植物功能衰竭和排斥风险。这些发现强调需要制定针对性的管理和监测策略，以改善接受多次肾脏再次移植患者的结局。
