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Bellini MI, Courtney AE, McCaughan JA. Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants. J Clin Med. 2020;9(7)doi: 10.3390/jcm9072118.
Bellini, M. I., Courtney, A. E., & McCaughan, J. A. (2020). Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants. Journal of clinical medicine, 9(7), . https://doi.org/10.3390/jcm9072118
Bellini, Maria Irene, et al. "Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants." Journal of clinical medicine vol. 9,7 (2020). doi: https://doi.org/10.3390/jcm9072118
Bellini MI, Courtney AE, McCaughan JA. Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants. J Clin Med. 2020 Jul 05;9(7). doi: 10.3390/jcm9072118. PMID: 32635614; PMCID: PMC7408952.
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J Clin Med. 2020 Jul 05;9(7). doi: 10.3390/jcm9072118.

Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants.

Journal of clinical medicine

Maria Irene Bellini, Aisling E Courtney, Jennifer A McCaughan

Affiliations

  1. Regional Nephrology and Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast BT9 7AB, UK.

PMID: 32635614 PMCID: PMC7408952 DOI: 10.3390/jcm9072118

Abstract

BACKGROUND: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients' factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor's pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context.

METHODS: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included.

RESULTS: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (

CONCLUSIONS: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival-in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.

Keywords: graft survival; living donation; patient survival; pre-emptive transplantation; prolonged ischaemic time; repeated kidney transplantation

References

  1. J Int Med Res. 2019 Jun;47(6):2323-2325 - PubMed
  2. Transplantation. 2006 Mar 27;81(6):840-4 - PubMed
  3. Transpl Int. 2016 Jan;29(1):81-7 - PubMed
  4. Biomed Res Int. 2019 Jun 11;2019:7423158 - PubMed
  5. Transplantation. 2015 Feb;99(2):416-23 - PubMed
  6. BMJ. 2015 Jul 31;351:h3557 - PubMed
  7. Transpl Int. 2017 Aug;30(8):844-846 - PubMed
  8. Am J Transplant. 2002 Nov;2(10):970-4 - PubMed
  9. Nephrol Dial Transplant. 2018 Apr 1;33(4):700-708 - PubMed
  10. Transplant Proc. 2008 Nov;40(9):2889-90 - PubMed
  11. Transpl Int. 2020 Jun;33(6):617-631 - PubMed
  12. Ann Surg. 2019 Feb;269(2):e18-e23 - PubMed
  13. Am J Transplant. 2015 Nov;15(11):2947-54 - PubMed
  14. Transplant Res. 2014 Sep 24;3:18 - PubMed
  15. Cureus. 2020 May 21;12(5):e8217 - PubMed
  16. Am J Transplant. 2005 Jul;5(7):1719-24 - PubMed
  17. Lancet. 2004 Nov 13-19;364(9447):1814-27 - PubMed
  18. Nephrol Dial Transplant. 2009 Feb;24(2):639-42 - PubMed
  19. J Clin Med. 2019 Aug 15;8(8): - PubMed
  20. Exp Clin Transplant. 2020 Apr;18(2):169-176 - PubMed
  21. Transpl Int. 2020 Jun;33(6):612-614 - PubMed
  22. Biomed Res Int. 2019 Jan 16;2019:7435248 - PubMed
  23. Transplantation. 2019 Jul;103(7):1494-1503 - PubMed
  24. J Clin Med. 2019 Jun 20;8(6): - PubMed
  25. Transplant Proc. 2005 Sep;37(7):2957-61 - PubMed
  26. Transpl Int. 2019 Sep;32(9):949-959 - PubMed
  27. Am J Transplant. 2015 Mar;15(3):734-40 - PubMed
  28. Kidney Int. 2003 Aug;64(2):674-80 - PubMed

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