Factors influencing survival after kidney transplant failure

Abstract

BackgroundThe failure of a kidney transplant is now a common reason for initiation of dialysis therapy. Kidney transplant recipients commencing dialysis have greater morbidity and mortality than transplant-naïve, incident dialysis patients. This study aimed to identify variables associated with survival after graft failure.MethodsAll recipients of first, deceased donor kidney transplants performed in Northern Ireland between 1986 and 2005 who had a functioning graft at 12 months were included (n = 585). Clinical and blood-derived variables (age, gender, primary renal disease, diabetic status, smoking status, human leukocyte antigen (HLA) mismatch, acute rejection episodes, immunosuppression, cardiovascular disease, graft survival, haemoglobin, albumin, phosphate, C reactive protein, estimated glomerular filtration rate (eGFR), rate of eGFR decline, dialysis modality, and access) were collected prospectively and investigated for association with re-transplantation and survival. The association between re-transplantation and survival was explored by modelling re-transplantation as a time-dependent covariate.ResultsMedian follow-up time was 12.1 years. Recipients with a failing graft (158/585) demonstrated rapid loss of eGFR prior to graft failure, reducing the time available to plan for alternative renal replacement therapy. Median survival after graft failure was 3.0 years. In multivariate analysis, age and re-transplantation were associated with survival after graft failure. Re-transplantation was associated with an 88% reduction in mortality.ConclusionsOptimal management of kidney transplant recipients with failing grafts requires early recognition of declining function and proactive preparation for re-transplantation given the substantial survival benefit this confers. The survival benefit associated with re-transplantation persists after prolonged exposure to immunosuppressive therapy.

Niclosamide attenuates inflammatory cytokines via the autophagy pathway leading to improved outcomes in renal ischemia/reperfusion injury

“…A reperfusion procedure is employed to restore blood flow and reduce further tissue injury and reduce the inflammatory response ( 11 ). Recent advancements in treatment strategies have failed to address the issue of morbidity and mortality in patients undergoing renal transplant ( 12 ). Notably, higher mortality rates have been observed in males than females ( 13 ).…”

Assessment of a Dedicated Transplant Low Clearance Clinic and Patient Outcomes on Dialysis After Renal Allograft Loss at 2 UK Transplant Centers

“…Retransplantation, especially if preemptive, offers clear advantages in terms of quality of life and survival. 3 , 18 , 19 Retransplantation was associated with a 45% and 23% reduction in 5-year mortality in diabetic (type 1) and nondiabetic kidney disease in the United States, 3 and with an 88% reduction in overall mortality during 12 years follow-up in the United Kingdom. 18 Preemptive retransplantation is recommended in RFKT when eGFR falls to 10 to 15 mL/min per 1.73 m 2 .…”

The economic burden of kidney graft failure in the United States

“…In fact, graft failure among transplant recipients is so common that it is the fourth leading cause of end‐stage renal disease within the adult population at large . Once a graft fails, patient outcomes are dire: median overall survival following kidney graft failure was recently estimated to be just 3.0 years . Moreover, patients who experience graft loss find the event itself to be traumatic and disruptive .…”