Repeated kidney re-transplantation-the Eurotransplant experience: a retrospective multicenter outcome analysis

被引：21

作者：

Assfalg, Volker ^{[1
,2
]}

Selig, Katharina ^{[3
]}

Tolksdorf, Johanna ^{[3
]}

van Meel, Marieke ^{[4
]}

de Vries, Erwin ^{[4
]}

Ramsoebhag, Anne-Marie ^{[4
]}

Rahmel, Axel ^{[4
,33
]}

Renders, Lutz ^{[1
,5
]}

Novotny, Alexander ^{[1
,2
]}

Matevossian, Edouard ^{[1
,2
]}

Schneeberger, Stefan ^{[6
]}

Rosenkranz, Alexander R. ^{[7
]}

Berlakovich, Gabriela ^{[8
]}

Ysebaert, Dirk ^{[9
]}

Knops, Noel ^{[10
]}

Kuypers, Dirk ^{[11
]}

Weekers, Laurent ^{[12
]}

Muehlfeld, Anja ^{[13
]}

Rump, Lars-Christian ^{[14
]}

Hauser, Ingeborg ^{[15
]}

Pisarski, Przemyslaw ^{[16
]}

Weimer, Rolf ^{[17
]}

Fornara, Paolo ^{[18
]}

Fischer, Lutz ^{[19
]}

Kliem, Volker ^{[20
]}

Sester, Urban ^{[21
]}

Stippel, Dirk ^{[22
]}

Arns, Wolfgang ^{[23
]}

Hau, Hans-Michael ^{[24
]}

Nitschke, Martin ^{[25
]}

Hoyer, Joachim ^{[26
]}

Thorban, Stefan ^{[1
,2
]}

Weinmann-Menke, Julia ^{[27
]}

Heller, Katharina ^{[28
]}

Banas, Bernhard ^{[29
]}

Schwenger, Vedat ^{[30
]}

Nadalin, Silvio ^{[31
]}

Lopau, Kai ^{[32
]}

Hueser, Norbert ^{[1
,2
]}

Heemann, Uwe ^{[1
,5
]}

机构：

[1] Tech Univ Munich, Klinikum Rechts Isar, Munich Transplant Ctr, TransplanTUM,Sch Med, Munich, Germany

[2] Tech Univ Munich, Klinikum Rechts Isar, Sch Med, Dept Surg, Munich, Germany

[3] Tech Univ Munich, Dept Math, Garching, Germany

[4] Eurotransplant Int Fdn, Leiden, Netherlands

[5] Tech Univ Munich, Klinikum Rechts Isar, Sch Med, Dept Nephrol, Munich, Germany

[6] Med Univ Innsbruck, Univ Klin Visceral Transplantat & Thoraxchirurg I, Innsbruck, Austria

[7] Med Univ Graz, Div Nephrol, Graz, Austria

[8] Med Univ Vienna, Dept Surg, Div Transplantat, Vienna, Austria

[9] Antwerp Univ, Antwerp Univ Hosp, Dept Surg, Edegem, Belgium

[10] Univ Hosp Leuven, Dept Pediat Nephrol, Leuven, Belgium

[11] Univ Hosp Leuven, Dept Nephrol, Leuven, Belgium

[12] CHU Liege, Dept Nephrol, Domaine Univ Sart Tilman, Liege, Belgium

[13] Uniklin RWTH Aachen, Klin Nieren & Hochdruckkrankheiten Rheumatol & Im, Aachen, Germany

[14] Univ Klinikum Dusseldorf, Dept Internal Med Nephrol, Dusseldorf, Germany

[15] Goethe Univ Frankfurt, Univ Clin Frankfurt, Dept Nephrol, Frankfurt, Germany

[16] Univ Klinikum Freiburg, Dept Surg, Freiburg, Germany

[17] Univ Klinikum Giessen & Marburg GmbH, Transplant Ctr, Giessen, Germany

[18] Martin Luther Univ Halle Wittenberg, Univ Klinikum Halle, Dept Urol, Fak Med, Halle, Germany

[19] Univ Klinikum Hamburg Eppendorf, Dept Hepatobiliary & Transplant Surg, Hamburg, Germany

[20] Transplantat Zentrum Hann, Nephrol Zentrum Niedersachsen, Munden, Hannoversch Mun, Germany

[21] Univ Klinikum Homburg, Transplant Zentrum Saarlandes, Homburg, Germany

[22] Univ Klinikum Koln, Dept Surg, Cologne, Germany

[23] Univ Witten Herdecke, Krankenhaus Koln Merheim Klinikum, Dept Nephrol, Cologne, Germany

[24] Univ Klinikum Leipzig, Dept Surg, Leipzig, Germany

[25] Univ Klinikum Schleswig Holstein, Dept Nephrol, Lubeck, Germany

[26] Univ Klinikum Marburg, Klin Innere Med Nephrol & Internist Intens Med, Marburg, Germany

[27] Johannes Gutenberg Univ Mainz, Med Klin & Poliklin 1, Dept Nephrol, Mainz, Germany

[28] Univ Klinikum Erlangen, Dept Nephrol, Erlangen, Germany

[29] Univ Klinikum Regensburg, Dept Nephrol, Regensburg, Germany

[30] Katharinenhospital, Klinikum Stuttgart, Transplantat Zentrum, Stuttgart, Germany

[31] Univ Klinikum Tubingen, Dept Surg, Tubingen, Germany

[32] Univ Klinikum Wurzburg, Zentrum Innere Med, Nephrol, Wurzburg, Germany

[33] DSO, Deutsch Stiftung Organtransplantat, Deutschherrnufer 52, D-60594 Frankfurt, Germany

来源：

TRANSPLANT INTERNATIONAL | 2020年 / 33卷 / 06期

关键词：

allocation; child; fourth; graft; kidney; loss; repeated; re-transplantation; survival; third; GRAFT LOSS; COMPETING RISKS; SINGLE-CENTER; 3RD; ALLOCATION; SURVIVAL; 2ND; RECIPIENTS; 1ST; SUCCESS;

D O I：

10.1111/tri.13569

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re-transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15-year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re-DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and >= 4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re-DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re-DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for >= 4th DDRT.

引用

页码：617 / 631

页数：15

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