Open AccessPreemptive second kidney transplantation is associated with better graft survival compared with non‐preemptive second transplantation: a multicenter French 2000–2014 cohort study
Author(s) -
Girerd Sophie,
Girerd Nicolas,
Duarte Kevin,
Giral Magali,
Legendre Christophe,
Mourad Georges,
Garrigue Valérie,
Morelon Emmanuel,
Buron Fanny,
Kamar Nassim,
Del Bello Arnaud,
Ladrière Marc,
Kessler Michèle,
Frimat Luc
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13105
Subject(s) - medicine , transplantation , dialysis , kidney transplantation , cohort , propensity score matching , retrospective cohort study , cohort study , multicenter study , surgery , randomized controlled trial
Summary The impact of preemptive second kidney transplantation (2 KT ) on graft and patient survival is poorly established. The association between preemptive 2 KT (p2 KT , N = 93) and outcomes was estimated in a multicenter French cohort of 2 KT ( N = 1314) recipients using propensity score methods. During the follow‐up, there were 274 returns to dialysis and 134 deaths. p2 KT was associated with lower death‐censored graft loss ( HR = 0.39 [0.18–0.88], P = 0.024) and graft failure from any cause including death ( HR = 0.42 [0.22–0.80], P = 0.008). Similar associations were observed for death with a functioning graft, although not reaching statistical significance ( HR = 0.47 [0.17–1.26], P = 0.13). There was a significant interaction between donor type and p2 KT ( P for interaction = 0.016). Indeed, p2 KT was not significantly associated with the risk of graft failure from any cause including death in living donor 2 KT ( P = 0.39), whereas the association was substantial in the deceased donor subset ( HR = 0.30 [0.14–0.64], P = 0.002). Of note, the adjusted graft survival of p2 KT with deceased donor paralleled that of 2 KT with living donor, either preemptive or not (93.8% vs. 88.6% at 4 years and 76.1% vs. 70.5% at 8 years, P = 0.13). This large French multicenter study analyzed using propensity scores suggests that p2 KT is associated with better graft prognosis.