Abstract
BackgroundThe failure of a kidney transplant is now a common reason for initiation of dialysis therapy. Kidney transplant recipients commencing dialysis have greater morbidity and mortality than transplant-naïve, incident dialysis patients. This study aimed to identify variables associated with survival after graft failure.MethodsAll recipients of first, deceased donor kidney transplants performed in Northern Ireland between 1986 and 2005 who had a functioning graft at 12 months were included (n = 585). Clinical and blood-derived variables (age, gender, primary renal disease, diabetic status, smoking status, human leukocyte antigen (HLA) mismatch, acute rejection episodes, immunosuppression, cardiovascular disease, graft survival, haemoglobin, albumin, phosphate, C reactive protein, estimated glomerular filtration rate (eGFR), rate of eGFR decline, dialysis modality, and access) were collected prospectively and investigated for association with re-transplantation and survival. The association between re-transplantation and survival was explored by modelling re-transplantation as a time-dependent covariate.ResultsMedian follow-up time was 12.1 years. Recipients with a failing graft (158/585) demonstrated rapid loss of eGFR prior to graft failure, reducing the time available to plan for alternative renal replacement therapy. Median survival after graft failure was 3.0 years. In multivariate analysis, age and re-transplantation were associated with survival after graft failure. Re-transplantation was associated with an 88% reduction in mortality.ConclusionsOptimal management of kidney transplant recipients with failing grafts requires early recognition of declining function and proactive preparation for re-transplantation given the substantial survival benefit this confers. The survival benefit associated with re-transplantation persists after prolonged exposure to immunosuppressive therapy.
Highlights
The failure of a kidney transplant is a common reason for initiation of dialysis therapy
Despite advances in kidney transplantation which have substantially reduced the rate of early graft loss, the impact on long-term graft survival has been disappointing [3,4]
While there is evidence that there may be sub-optimal management of transplant recipients in the pre-dialysis period, limited data has been published to highlight which modifiable clinical parameters are associated with survival following graft failure
Summary
The failure of a kidney transplant is a common reason for initiation of dialysis therapy. Kidney transplant recipients commencing dialysis have greater morbidity and mortality than transplant-naïve, incident dialysis patients. This study aimed to identify variables associated with survival after graft failure. The morbidity and mortality of kidney transplant recipients commencing dialysis are high [5,6,7,8,9,10,11]. Kidney transplant failure has ramifications for both transplant recipients and healthcare providers. While there is evidence that there may be sub-optimal management of transplant recipients in the pre-dialysis period, limited data has been published to highlight which modifiable clinical parameters are associated with survival following graft failure.
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