PROGNOSIS FOLLOWING PRIMARY RENAL ALLOGRAFT FAILURE

Abstract

19 Patient survival following primary renal allograft failure has not been well studied. A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed prospectively from the date of first allograft failure until death, retransplantation or 12/31/96. The mortality rates and the probability of wait-listing and retransplantation were calculated. The mortality risks associated with repeat transplantation were estimated with a time-dependent Cox survival model. At study closure, 36.8% of patients had died on dialysis; 46.8% were alive on dialysis; and 13.4% were alive with a functioning 2nd transplant. The adjusted 5-year patient survival was 41% for Type I diabetics (DM) compared to 69% for other ESRD diagnoses (P<0.001). The adjusted 5-yr patient survival was 62%, 70% and 70% for Whites, Blacks and Others, respectively (p<0.01). 24% of all patients were wait-listed (WL) for a 2nd transplant within one year following allograft failure. The mortality rate for WL Type I DM was 116 vs. 34/1,000 patient-years for WL other ESRD diagnoses (p<0.001). The retransplantation rate in the WL sub-cohort was 21%, 35%, and 55% at 1, 2 and 5 years, respectively. The second transplantation was associated with transient increase in the relative risk of death (RR=1.39) which had dissipated by 3 months posttransplant. Retransplantation was associated with 33% long-term reduction in mortality compared to the previously transplanted, WL dialysis group. The survival benefit of retransplantation was greater for Type I DM compared to other ESRD diagnoses. We conclude that loss of a primary allograft is associated with significant mortality, especially in recipients with Type I DM. Retransplantation was associated with a substantial long-term improvement in patient survival. Recipients with Type I DM achieved the greatest proportional benefit from retransplantation. Table