Survival in Southern European Patients Waitlisted for Kidney Transplant After Graft Failure: A Competing Risk Analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Mar 8

PMID 29513701

Citations 3

Authors

Domingo Hernandez

Alfonso Muriel

Pablo Castro de la Nuez

Juana Alonso-Titos

Pedro Ruiz-Esteban

Ana Duarte

Miguel Gonzalez-Molina

Eulalia Palma

Manuel Alonso

Armando Torres

Affiliations

Soon will be listed here.

Abstract

Background: Whether patients waitlisted for a second transplant after failure of a previous kidney graft have higher mortality than transplant-näive waitlisted patients is uncertain.

Methods: We assessed the relationship between a failed transplant and mortality in 3851 adult KT candidates, listed between 1984-2012, using a competing risk analysis in the total population and in a propensity score-matched cohort. Mortality was also modeled by inverse probability weighting (IPTW) competing risk regression.

Results: At waitlist entry 225 (5.8%) patients had experienced transplant failure. All-cause mortality was higher in the post-graft failure group (16% vs. 11%; P = 0.033). Most deaths occurred within three years after listing. Cardiovascular disease was the leading cause of death (25.3%), followed by infections (19.3%). Multivariate competing risk regression showed that prior transplant failure was associated with a 1.5-fold increased risk of mortality (95% confidence interval [CI], 1.01-2.2). After propensity score matching (1:5), the competing risk regression model revealed a subhazard ratio (SHR) of 1.6 (95% CI, 1.01-2.5). A similar mortality risk was observed after the IPTW analysis (SHR, 1.7; 95% CI, 1.1-2.6).

Conclusions: Previous transplant failure is associated with increased mortality among KT candidates after relisting. This information is important in daily clinical practice when assessing relisted patients for a retransplant.

Citing Articles

Evaluating tuberculosis treatment outcomes in Haiti from 2018 to 2019: A competing risk analysis.

Raphael N, Garraud P, Roelens M, Alfred J, Richard M, Estill J IJID Reg. 2024; 11:100350.

PMID: 38577553 PMC: 10993134. DOI: 10.1016/j.ijregi.2024.03.005.

Rationale for Surrogate Endpoints and Conditional Marketing Authorization of New Therapies for Kidney Transplantation.

Naesens M, Loupy A, Hilbrands L, Oberbauer R, Bellini M, Glotz D Transpl Int. 2022; 35:10137.

PMID: 35669977 PMC: 9163307. DOI: 10.3389/ti.2022.10137.

Management of chronic renal allograft dysfunction and when to re-transplant.

Baker R, Marks S Pediatr Nephrol. 2018; 34(4):599-603.

PMID: 30039433 PMC: 6394652. DOI: 10.1007/s00467-018-4000-9.

References

Mourad G, Minguet J, Pernin V, Garrigue V, Peraldi M, Kessler M . Similar patient survival following kidney allograft failure compared with non-transplanted patients. Kidney Int. 2014; 86(1):191-8. DOI: 10.1038/ki.2014.6. View

DAgostino Jr R . Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998; 17(19):2265-81. DOI: 10.1002/(sici)1097-0258(19981015)17:19<2265::aid-sim918>3.0.co;2-b. View

Austin P, Grootendorst P, Anderson G . A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med. 2006; 26(4):734-53. DOI: 10.1002/sim.2580. View

Sleiman J, Garrigue V, Vetromile F, Mourad G . Return to dialysis after renal allograft loss: is dialysis treatment initiated too late?. Transplant Proc. 2007; 39(8):2597-8. DOI: 10.1016/j.transproceed.2007.08.030. View

Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C . Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int. 1999; 55(2):648-58. DOI: 10.1046/j.1523-1755.1999.00273.x. View

Magee J, Barr M, Basadonna G, Johnson M, Mahadevan S, McBride M . Repeat organ transplantation in the United States, 1996-2005. Am J Transplant. 2007; 7(5 Pt 2):1424-33. DOI: 10.1111/j.1600-6143.2007.01786.x. View

Ojo A, Wolfe R, Agodoa L, Held P, Port F, Leavey S . Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System. Transplantation. 1999; 66(12):1651-9. DOI: 10.1097/00007890-199812270-00014. View

Noordzij M, Leffondre K, van Stralen K, Zoccali C, Dekker F, Jager K . When do we need competing risks methods for survival analysis in nephrology?. Nephrol Dial Transplant. 2013; 28(11):2670-7. DOI: 10.1093/ndt/gft355. View

Austin P . Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol. 2010; 172(9):1092-7. PMC: 2962254. DOI: 10.1093/aje/kwq224. View

10.

Ojo A, Morales J, Gonzalez-Molina M, Steffick D, Luan F, Merion R . Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant. 2012; 28(1):213-20. PMC: 3616762. DOI: 10.1093/ndt/gfs287. View

11.

Molnar M, Ichii H, Lineen J, Foster 3rd C, Mathe Z, Schiff J . Timing of return to dialysis in patients with failing kidney transplants. Semin Dial. 2013; 26(6):667-74. DOI: 10.1111/sdi.12129. View

12.

Hernandez D, Perez G, Marrero D, Porrini E, Rufino M, Gonzalez-Posada J . Early association of low-grade albuminuria and allograft dysfunction predicts renal transplant outcomes. Transplantation. 2012; 93(3):297-303. DOI: 10.1097/TP.0b013e31823ec0a7. View

13.

Fernandez Fresnedo G, Ruiz J, Gomez Alamillo C, de Francisco A, Arias M . Survival after dialysis initiation: a comparison of transplant patients after graft loss versus nontransplant patients. Transplant Proc. 2008; 40(9):2889-90. DOI: 10.1016/j.transproceed.2008.08.094. View

14.

Wong G, Chua S, Chadban S, Clayton P, Pilmore H, Hughes P . Waiting Time Between Failure of First Graft and Second Kidney Transplant and Graft and Patient Survival. Transplantation. 2015; 100(8):1767-75. DOI: 10.1097/TP.0000000000000953. View

15.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

16.

Perl J, Zhang J, Gillespie B, Wikstrom B, Fort J, Hasegawa T . Reduced survival and quality of life following return to dialysis after transplant failure: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2012; 27(12):4464-72. PMC: 3616760. DOI: 10.1093/ndt/gfs386. View

17.

Hernandez D, Castro de la Nuez P, Muriel A, Ruiz-Esteban P, Rudas E, Gonzalez-Molina M . Peripheral Vascular Disease and Death in Southern European Kidney Transplant Candidates: A Competing Risk Modeling Approach. Transplantation. 2016; 101(6):1320-1326. DOI: 10.1097/TP.0000000000001294. View

18.

Gaston R, Kasiske B, Fieberg A, Leduc R, Cosio F, Gourishankar S . Use of cardioprotective medications in kidney transplant recipients. Am J Transplant. 2009; 9(8):1811-5. DOI: 10.1111/j.1600-6143.2009.02696.x. View

19.

Molnar M, Streja E, Kovesdy C, Hoshino J, Hatamizadeh P, Glassock R . Estimated glomerular filtration rate at reinitiation of dialysis and mortality in failed kidney transplant recipients. Nephrol Dial Transplant. 2012; 27(7):2913-21. PMC: 3398063. DOI: 10.1093/ndt/gfs004. View

20.

Marcen R . Immunosuppressive drugs in kidney transplantation: impact on patient survival, and incidence of cardiovascular disease, malignancy and infection. Drugs. 2009; 69(16):2227-43. DOI: 10.2165/11319260-000000000-00000. View