Preemptive second kidney transplantation is associated with better graft survival compared with non ‐preemptive second transplantation: a multicenter French 2000–2014 cohort study

Summary The impact of preemptive second kidney transplantation (2KT) on graft and patient survival is poorly established. The association between preemptive 2KT (p2KT, N = 93) and outcomes was estimated in a multicenter French cohort of 2KT (N = 1314) recipients using propensity score methods. During the follow‐up, there were 274 returns to dialysis and 134 deaths. p2KT was associated with lower death‐censored graft loss (HR = 0.39 [0.18–0.88], P = 0.024) and graft failure from any cause including death (HR = 0.42 [0.22–0.80], P = 0.008). Similar associations were observed for death with a functioning graft, although not reaching statistical significance (HR = 0.47 [0.17–1.26], P = 0.13). There was a significant interaction between donor type and p2KT (P for interaction = 0.016). Indeed, p2KT was not significantly associated with the risk of graft failure from any cause including death in living donor 2KT (P = 0.39), whereas the association was substantial in the deceased donor subset (HR = 0.30 [0.14–0.64], P = 0.002). Of note, the adjusted graft survival of p2KT with deceased donor paralleled that of 2KT with living donor, either preemptive or not (93.8% vs. 88.6% at 4 years and 76.1% vs. 70.5% at 8 years, P = 0.13). This large French multicenter study analyzed using propensity scores suggests that p2KT is associated with better graft prognosis.
Source: Transplant International - Category: Transplant Surgery Authors: Tags: Original Article Source Type: research