Disclosures: Girerd reports no relevant financial disclosures.
June 03, 2022
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Patients benefit from second kidney transplant instead of dialysis

Disclosures: Girerd reports no relevant financial disclosures.
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A second kidney transplant correlates with better survival compared with dialysis treatment, according to data published in the American Journal of Transplantation.

However, the advantage of survival declines as patients age older than 70 years.

According to data published in the American Journal of Transplantation, 61.3% of patients were registered for a second kidney transplant either before or after returning to dialysis.
Data were derived from Girerd S, et al. Am J Transplant.2022;doi:10.1111/ajt.17081.

“In the present study conducted in the French Renal Epidemiology and information Network (REIN) registry of dialysis patients, we aimed to assess the association between kidney re-transplantation and survival according to age at the time of return to dialysis after a first graft failure,” Sophie Girerd, MD, PhD, from the Université de Lorraine in France, and colleagues wrote.

Girerd and colleagues conducted a large multicenter study of 5,334 patients who returned to dialysis or received a second preemptive kidney transplant between 2008 and 2015 following a first kidney transplant. Death was considered the primary outcome during the follow-up period until 2019. Researchers conducted a propensity score-based analysis to determine the correlation between two kidney transplants and death.

Overall, 61.3% of patients were registered for a second kidney transplant either before or after returning to dialysis. A second transplantation correlated with better overall survival compared with those who remained on dialysis. However, the increased survival from a second transplantation slowly declined as patients aged more than 70 years old.

“The present study could help clinicians to better disclose the risk and benefits of a second transplantation to their patients who have returned to dialysis. Although there is no doubt that re-transplantation is beneficial for the majority of the youngest patients with no contraindication for transplantation, such benefit still remains uncertain for older patients. The decision to wait list a patient or not for a [second transplantation] is frequently difficult, in particular for the oldest patients with an uncertain benefit/risk ratio. It represents a clinical challenge for the frailest patients,” Girerd and colleagues wrote. “The overall benefit of transplantation, as well as re-transplantation, may be considered as homogenous by patients and some physicians – whereas it is not in light of our results.”