WH LIM1,2, S CHADBAN2,3, H PILMORE4, P CLAYTON2,5, SP MCDONALD2,5, G WONG6
1Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth; 2ANZDATA Registry, Adelaide; 3Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney; 4Department of Renal Medicine, Auckland Hospital, Auckland; 5Department of Renal Medicine, Royal Adelaide Hospital, Adelaide; 6Centre for Kidney Research & Department of Renal Medicine, Westmead Hospital, Sydney,
Aim: To determine the association between retransplantation and mortality after primary kidney allograft loss.
Background: The reported estimates of mortality following renal allograft loss has been poorly described, which may reflect the variability in patient characteristics in those who were deemed suitable for retransplantation or remained on dialysis.
Methods: Using ANZDATA registry, the association between study groups (patients who were retransplanted vs. not retransplanted [i.e. remained on dialysis] after allograft loss) and all-cause mortality were examined using Cox regression analysis.
Results: Of 5770 patients with failed primary kidney allografts between 1980-2014, 2330 (40.4%) were retransplanted. Retransplanted patients were younger (mean[SD] 35.4[13.3] vs. 46.5[14.7], p<0.01) at graft loss, but had shorter mean first allograft duration (6.0[6.4] vs. 7.0[7.0], p<0.01) compared to those who were not retransplanted. Of patients who were not retransplanted, 76% died within 5 years of graft loss, compared to 17% in those who were retransplanted (p<0.01). Cardiovascular disease was the most frequent cause of mortality after graft loss for patients who were and were not retransplanted (32% vs. 38%), whereas cancer mortality was almost 4-times as common in patients who were retransplanted (15% vs. 4%; p<0.01). Compared to patients who were not retransplanted, retransplanted patients were less likely to die following graft loss, with adjusted hazard ratio (HR) of 0.22 (95%CI 0.20-0.24). Following exclusion of patients who had died within the first year post-graft loss, the adjusted HR for all-cause mortality was 0.27 (95%CI 0.24-0.30). Conclusions: Following failed kidney allografts, patients who were not retransplanted were at a greater risk of mortality compared to those who were retransplanted, with over 75% of deaths occurring within 5 years of allograft loss