Long-Term Outcome of Kidney Re-Transplantation in Comparison with First Kidney Transplantation: a Report from Thai Transplant Registry

Abstract

Introduction: Kidney re-transplantation is a high-risk procedure which is increasingly performed because of previous graft failure. The aim of this study was to determine the long term outcomes of kidney retransplantation compared with the first kidney transplantation under the current era of new immunosuppressions. Methods: Since the first re-transplantation in Thailand was performed in 1993, this study included all consecutive cases registered in the Thai Transplant Registry database from January 1993 to December 2011. A total of 3,337 kidney transplants were available for the analysis. Graft loss was defined as return to dialysis or graft removal. Death with functioning graft was considered as censored. Results: Of 3,337 kidney transplantations between study periods, 113 were second and 3 were third transplantation. Among these 116 re-transplantation recipients, the most common identified causes of the end-stage renal disease included chronic glomerulonephritis (38.8%), followed by hypertensive nephropathy (13.0%), diabetic nephropathy (6.0%) and lupus nephritis (1.7%). The re-transplanted recipients were older (mean age 46.2 + 12.8 years) than first transplant group (mean age 42.2 + 12.8 years). The proportion of living-related kidney transplant and male gender were similar between first kidney transplant recipients and retransplanted recipients. Fourteen percent of re-transplant recipients showed high immunologic risk as defined by current panel reactive antibodies (PRA) > 30% compared with 3% of those in first transplant group (P< 0.001). The percentages of induction therapy with antithymocyte globulin and anti-interleukin 2 antibody in re-transplant group and first transplant group were 18.3% vs. 4.3% and 60.0% vs. 32.6%, respectively. In addition, retransplant group had higher proportion of induction therapy with antithymocyte globulin (18.3%) and anti-interleukin 2 antibody (60.0%) when compared with those in first transplant group(. The graft survival rates (95%CI) at 1, 5 and 10 years were 88.6% (80.7-93.3), 87.3% (79.1-92.5) and 74.4%(53.7-86.9) among re-transplants, versus 95.0% (94.1-95.7), 87.0% (85.5-88.5) and 70.7%(67.4-73.8) in first transplant group, respectively (P=0.63). Patient survival rates were 95.1%(88.6-97.9), 95.1%(88.6-97.9) and 90.9%(76.6-96.7) in re-transplant group, versus 96.1%(95.4-96.8), 90.9%(89.6-92.1) and 83.7%(81.2-86.0) in first transplant group at 1, 5 and 10years respectively(P=0.42). The leading cause of graft loss among re-transplant group was chronic allograft nephropathy (21%) whereas infection (14%) was the major cause of death among this group. Conclusion: The 10 year patient and graft survival of kidney retransplantation is good. Combination of induction therapy, CNI and MMF/MPA based regimens can lead the outcomes comparable with the nonsensitized first kidney transplantation in our cohort of 3337 patients.