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Original ArticleTransplantation
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Waiting Time for Second Kidney Transplantation and Mortality

Alexander Kainz, Michael Kammer, Roman Reindl-Schwaighofer, Susanne Strohmaier, Vojtěch Petr, Ondrej Viklicky, Daniel Abramowicz, Marcel Naik, Gert Mayer and Rainer Oberbauer
CJASN January 2022, 17 (1) 90-97; DOI: https://doi.org/10.2215/CJN.07620621
Alexander Kainz
1Department of Nephrology, Medical University of Vienna, Vienna, Austria
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Michael Kammer
1Department of Nephrology, Medical University of Vienna, Vienna, Austria
2Institute of Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
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Roman Reindl-Schwaighofer
1Department of Nephrology, Medical University of Vienna, Vienna, Austria
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Susanne Strohmaier
3Department of Epidemiology, Medical University of Vienna, Vienna, Austria
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Vojtěch Petr
4Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Ondrej Viklicky
4Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Daniel Abramowicz
5Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
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Marcel Naik
6Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin, Berlin, Germany
7Berlin Institute of Health, Berlin, Germany
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Gert Mayer
8Department of Internal Medicine IV–Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
9Austrian Dialysis and Transplant Registry, Innsbruck, Austria
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Rainer Oberbauer
1Department of Nephrology, Medical University of Vienna, Vienna, Austria
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Abstract

Background and objectives The median kidney transplant half-life is 10–15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list.

Design, setting, participants, & measurements In this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980–2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies “retransplant” versus “remain waitlisted with maintenance dialysis” are reported for different waiting times after first graft loss.

Results Second kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, −14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively.

Conclusions Second kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.

  • second kidney transplantation
  • patient survival
  • target trial emulation
  • restricted mean survival time
  • kidney transplantation
  • waiting lists
  • Received June 2, 2021.
  • Accepted October 11, 2021.
  • Copyright © 2022 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 17 (1)
Clinical Journal of the American Society of Nephrology
Vol. 17, Issue 1
January 2022
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Waiting Time for Second Kidney Transplantation and Mortality
Alexander Kainz, Michael Kammer, Roman Reindl-Schwaighofer, Susanne Strohmaier, Vojtěch Petr, Ondrej Viklicky, Daniel Abramowicz, Marcel Naik, Gert Mayer, Rainer Oberbauer
CJASN Jan 2022, 17 (1) 90-97; DOI: 10.2215/CJN.07620621

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Waiting Time for Second Kidney Transplantation and Mortality
Alexander Kainz, Michael Kammer, Roman Reindl-Schwaighofer, Susanne Strohmaier, Vojtěch Petr, Ondrej Viklicky, Daniel Abramowicz, Marcel Naik, Gert Mayer, Rainer Oberbauer
CJASN Jan 2022, 17 (1) 90-97; DOI: 10.2215/CJN.07620621
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Keywords

  • second kidney transplantation
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