Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

Assfalg V, Selig K, Tolksdorf J, Van Meel M, De Vries E, Ramsoebhag AM, Rahmel A, Renders L, Novotny A, Matevossian E, Schneeberger S, Rosenkranz AR, Berlakovich G, Ysebaert D, Knops N, Kuypers D, Weekers L, Muehlfeld A, Rump LC, Hauser I, Pisarski P, Weimer R, Fornara P, Fischer L, Kliem V, Sester U, Stippel D, Arns W, Hau HM, Nitschke M, Hoyer J, Thorban S, Weinmann-Menke J, Heller K, Banas B, Schwenger V, Nadalin S, Lopau K, Hueser N, Heemann U (2020)

Publication Type: Journal article

Publication year: 2020

Journal

DOI: 10.1111/tri.13569

Abstract

In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re-transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15-year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re-DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and ≥4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re-DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re-DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for ≥4th DDRT.

Involved external institutions

Technische Universität München (TUM) Germany (DE) Eurotransplant Netherlands (NL) University of Antwerp / Universiteit Antwerpen Belgium (BE) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Goethe-Universität Frankfurt am Main Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Universität Witten/Herdecke Germany (DE) Universitätsklinikum Tübingen Germany (DE) Universitätsklinikum Leipzig Germany (DE) Universitätsklinikum Regensburg Germany (DE) Universitätsklinikum Freiburg Germany (DE) Centre Hospitalier Universitaire de Liège (CHU Liège) Belgium (BE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Medizinische Universität Innsbruck Austria (AT) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Düsseldorf Germany (DE) Medizinische Universität Wien Austria (AT) Katharinenhospital Stuttgart Germany (DE) Johannes Gutenberg-Universität Mainz (JGU) Germany (DE) Universitätsklinikum Köln Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE)

How to cite

APA:

Assfalg, V., Selig, K., Tolksdorf, J., Van Meel, M., De Vries, E., Ramsoebhag, A.-M.,... Heemann, U. (2020). Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis. Transplant International. https://doi.org/10.1111/tri.13569

MLA:

Assfalg, Volker, et al. "Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis." Transplant International (2020).

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