Article (Scientific journals)
Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis
Assfalg, V.; Selig, K.; Tolksdorf, J. et al.
2020In Transplant International, 33 (6), p. 617-631
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Keywords :
kidney transplantation; Allocation; Re-transplanation
Abstract :
[en] 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. © 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT
Disciplines :
Urology & nephrology
Author, co-author :
Assfalg, V.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Selig, K.;  Department of Mathematics, Technical University of Munich, Garching near Munich, Germany
Tolksdorf, J.;  Department of Mathematics, Technical University of Munich, Garching near Munich, Germany
van Meel, M.;  Eurotransplant International Foundation, Leiden, Netherlands
de Vries, E.;  Eurotransplant International Foundation, Leiden, Netherlands
Ramsoebhag, A.-M.;  Eurotransplant International Foundation, Leiden, Netherlands
Rahmel, A.;  Eurotransplant International Foundation, Leiden, Netherlands, Deutsche Stiftung Organtransplantation, DSO, Deutschherrnufer 52, Frankfurt, D-60594, Germany
Renders, L.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Novotny, A.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Matevossian, E.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Schneeberger, S.;  Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
Rosenkranz, A. R.;  Division of Nephrology, Medical University of Graz, Graz, Austria
Berlakovich, G.;  Division of Transplantation, Department of Surgery, Medical University of Vienna, Wien, Austria
Ysebaert, D.;  Department of Surgery, Antwerp University Hospital, Antwerp University, Edegem, Belgium
Knops, N.;  Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
Kuypers, D.;  Depertmant of Nephrology, University Hospitals Leuven, Leuven, Belgium
WEEKERS, Laurent  ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
Muehlfeld, A.;  Klinik für Nieren- und Hochdruckkrankheiten, Rheumatologische und Immunologische Erkrankungen, Uniklinik RWTH Aachen, Aachen, Germany
Rump, L.-C.;  Department of Internal Medicine/Nephrology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
Hauser, I.;  Department of Nephrology, Goethe University Frankfurt, University Clinic Frankfurt, Frankfurt/M, Germany
Pisarski, P.;  Department of Surgery, Universitätsklinikum Freiburg, Freiburg, Germany
Weimer, R.;  Transplant Center, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
Fornara, P.;  Department of Urology, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle, Halle, Germany
Fischer, L.;  Department of Hepatobiliary and Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Kliem, V.;  Nephrologisches Zentrum Niedersachsen, Transplantationszentrum Hann. Münden, Hannoversch Münden, Germany
Sester, U.;  Transplantationszentrum des Saarlandes, Universitätsklinikum Homburg, Homburg, Germany
Stippel, D.;  Department of Surgery, Universitätsklinikum Köln, Köln, Germany
Arns, W.;  Department of Nephrology, Krankenhaus Köln-Merheim – Klinikum der Universität Witten/Herdecke, Köln, Germany
Hau, H.-M.;  Department of Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
Nitschke, M.;  Department of Nephrology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
Hoyer, J.;  Klinik für Innere Medizin, Nephrologie und Internistische Intensivmedizin, Universitätsklinikum Marburg, Marburg, Germany
Thorban, S.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Weinmann-Menke, J.;  Department of Nephrology, I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, Mainz, Germany
Heller, K.;  Department of Nephrology, Universitätsklinikum Erlangen, Erlangen, Germany
Banas, B.;  Department of Nephrology, Universitätsklinikum Regensburg, Regensburg, Germany
Schwenger, V.;  Transplantationszentrum, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
Nadalin, S.;  Department of Surgery, Universitätsklinikum Tübingen, Tübingen, Germany
Lopau, K.;  Nephrologie, Zentrum Innere Medizin, Universitätsklinikum Würzburg, Würzburg, Germany
Hüser, N.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Heemann, U.;  School of Medicine, TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
More authors (30 more) Less
Language :
English
Title :
Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis
Publication date :
2020
Journal title :
Transplant International
ISSN :
0934-0874
eISSN :
1432-2277
Publisher :
Blackwell Publishing Ltd
Volume :
33
Issue :
6
Pages :
617-631
Peer reviewed :
Peer Reviewed verified by ORBi
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