Second Kidney Transplant Outcomes in Dialysis Dependent Recipients by Induction Type in the United States |
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| Affiliation: | 1. Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota;2. Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, Wisconsin;3. Complex Care Analytics, MHealth Fairview, Minneapolis, Minnesota;4. Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota;5. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota;1. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo Japan;2. Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan;1. Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea;2. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;3. Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Republic of Korea;4. Department of Surgery, Gachon Gil Hospital, Gacheon University College of Medicine, Incheon, Republic of Korea;5. Department of Surgery, Chosun University College of Medicine, Gwangju, Republic of Korea;6. Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea;7. Department of Surgery, Soon Chun Hyang University Seoul Hospital, Seoul, 04401, Republic of Korea;8. Department of Surgery, Cheju Halla General Hospital, Jeju-do, Republic of Korea;1. Department of Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio;2. Division of Cardiology, Newark Beth Israel Medical Center, Heart Failure Treatment and Transplant Program, Newark, New Jersey;3. Division of Cardiothoracic Surgery, Newark Beth Israel Medical Center, Newark, New Jersey |
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| Abstract: | BackgroundWe examined the association between induction type for a second kidney transplant in dialysis-dependent recipients and the long-term outcomes.MethodsUsing the Scientific Registry of Transplant Recipients, we identified all second kidney transplant recipients who returned to dialysis before re-transplantation. Exclusion criteria included: missing, unusual, or no-induction regimens, maintenance regimens other than tacrolimus and mycophenolate, and positive crossmatch status. We grouped recipients by induction type into 3 groups: the anti-thymocyte group (N = 9899), the alemtuzumab group (N = 1982), and the interleukin 2 receptor antagonist group (N = 1904). We analyzed recipient and death-censored graft survival (DCGS) using the Kaplan-Meier survival function with follow-up censored at 10 years post-transplant. We used Cox proportional hazard models to examine the association between induction and the outcomes of interest. To account for the center-specific effect, we included the center as a random effect. We adjusted the models for the pertinent recipient and organ variables.ResultsIn the Kaplan-Meier analyses, induction type did not alter recipient survival (log-rank P = .419) or DCGS (log-rank P = .146). Similarly, in the adjusted models, induction type was not a predictor of recipient or graft survival. Live-donor kidneys were associated with better recipient survival (HR 0.73, 95% CI [0.65, 0.83], P < .001) and graft survival (HR 0.72, 95% CI [0.64, 0.82], P < .001). Publicly insured recipients had worse recipient and allograft outcomes.ConclusionIn this large cohort of average immunologic-risk dialysis-dependent second kidney transplant recipients, who were discharged on tacrolimus and mycophenolate maintenance, induction type did not influence the long-term outcomes of recipient or graft survival. Live-donor kidneys improved recipient and graft survival. |
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