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

Volker Assfalg; Katharina Selig; Johanna Tolksdorf; Marieke van Meel; Erwin de Vries; Anne Marie Ramsoebhag; Axel Rahmel; Lutz Renders; Alexander Novotny; Edouard Matevossian; Stefan Schneeberger; Alexander R. Rosenkranz; Gabriela Berlakovich; Dirk Ysebaert; Noël Knops; Dirk Kuypers; Laurent Weekers; Anja Muehlfeld; Lars Christian Rump; Ingeborg Hauser; Przemyslaw Pisarski; Rolf Weimer; Paolo Fornara; Lutz Fischer; Volker Kliem; Urban Sester; Dirk Stippel; Wolfgang Arns; Hans Michael Hau; Martin Nitschke; Joachim Hoyer; Stefan Thorban; Julia Weinmann-Menke; Katharina Heller; Bernhard Banas; Vedat Schwenger; Silvio Nadalin; Kai Lopau; Norbert Hüser; Uwe Heemann

doi:10.1111/tri.13569

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

Volker Assfalg^*, Katharina Selig, Johanna Tolksdorf, Marieke van Meel, Erwin de Vries, Anne Marie Ramsoebhag, Axel Rahmel, Lutz Renders, Alexander Novotny, Edouard Matevossian, Stefan Schneeberger, Alexander R. Rosenkranz, Gabriela Berlakovich, Dirk Ysebaert, Noël Knops, Dirk Kuypers, Laurent Weekers, Anja Muehlfeld, Lars Christian Rump, Ingeborg HauserPrzemyslaw Pisarski, Rolf Weimer, Paolo Fornara, Lutz Fischer, Volker Kliem, Urban Sester, Dirk Stippel, Wolfgang Arns, Hans Michael Hau, Martin Nitschke, Joachim Hoyer, Stefan Thorban, Julia Weinmann-Menke, Katharina Heller, Bernhard Banas, Vedat Schwenger, Silvio Nadalin, Kai Lopau, Norbert Hüser, Uwe Heemann

^*Corresponding author for this work

Clinic of Internal Medicine I

2 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Transplant International
Volume	33
Issue number	6
Pages (from-to)	617-631
Number of pages	15
ISSN	0934-0874
DOIs	https://doi.org/10.1111/tri.13569
Publication status	Published - 01.06.2020

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Assfalg, V., Selig, K., Tolksdorf, J., van Meel, M., de Vries, E., Ramsoebhag, A. M., Rahmel, A., Renders, L., Novotny, A., Matevossian, E., Schneeberger, S., Rosenkranz, A. R., Berlakovich, G., Ysebaert, D., Knops, N., Kuypers, D., Weekers, L., Muehlfeld, A., Rump, L. C., ... Heemann, U. (2020). Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis. Transplant International, 33(6), 617-631. https://doi.org/10.1111/tri.13569

@article{7237db6b8e5543c6ab42d95dee75896c,

title = "Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis",

abstract = "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.",

author = "Volker Assfalg and Katharina Selig and Johanna Tolksdorf and {van Meel}, Marieke and {de Vries}, Erwin and Ramsoebhag, {Anne Marie} and Axel Rahmel and Lutz Renders and Alexander Novotny and Edouard Matevossian and Stefan Schneeberger and Rosenkranz, {Alexander R.} and Gabriela Berlakovich and Dirk Ysebaert and No{\"e}l Knops and Dirk Kuypers and Laurent Weekers and Anja Muehlfeld and Rump, {Lars Christian} and Ingeborg Hauser and Przemyslaw Pisarski and Rolf Weimer and Paolo Fornara and Lutz Fischer and Volker Kliem and Urban Sester and Dirk Stippel and Wolfgang Arns and Hau, {Hans Michael} and Martin Nitschke and Joachim Hoyer and Stefan Thorban and Julia Weinmann-Menke and Katharina Heller and Bernhard Banas and Vedat Schwenger and Silvio Nadalin and Kai Lopau and Norbert H{\"u}ser and Uwe Heemann",

note = "Publisher Copyright: {\textcopyright} 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = jun,

day = "1",

doi = "10.1111/tri.13569",

language = "English",

volume = "33",

pages = "617--631",

journal = "Transplant International",

issn = "0934-0874",

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Assfalg, V, Selig, K, Tolksdorf, J, van Meel, M, de Vries, E, Ramsoebhag, AM, Rahmel, A, Renders, L, Novotny, A, Matevossian, E, Schneeberger, S, Rosenkranz, AR, Berlakovich, G, Ysebaert, D, Knops, N, Kuypers, D, Weekers, L, Muehlfeld, A, Rump, LC, Hauser, I, Pisarski, P, Weimer, R, Fornara, P, Fischer, L, Kliem, V, Sester, U, Stippel, D, Arns, W, Hau, HM, Nitschke, M, Hoyer, J, Thorban, S, Weinmann-Menke, J, Heller, K, Banas, B, Schwenger, V, Nadalin, S, Lopau, K, Hüser, N & Heemann, U 2020, 'Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis', Transplant International, vol. 33, no. 6, pp. 617-631. https://doi.org/10.1111/tri.13569

TY - JOUR

T1 - Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

AU - Assfalg, Volker

AU - Selig, Katharina

AU - Tolksdorf, Johanna

AU - van Meel, Marieke

AU - de Vries, Erwin

AU - Ramsoebhag, Anne Marie

AU - Rahmel, Axel

AU - Renders, Lutz

AU - Novotny, Alexander

AU - Matevossian, Edouard

AU - Schneeberger, Stefan

AU - Rosenkranz, Alexander R.

AU - Berlakovich, Gabriela

AU - Ysebaert, Dirk

AU - Knops, Noël

AU - Kuypers, Dirk

AU - Weekers, Laurent

AU - Muehlfeld, Anja

AU - Rump, Lars Christian

AU - Hauser, Ingeborg

AU - Pisarski, Przemyslaw

AU - Weimer, Rolf

AU - Fornara, Paolo

AU - Fischer, Lutz

AU - Kliem, Volker

AU - Sester, Urban

AU - Stippel, Dirk

AU - Arns, Wolfgang

AU - Hau, Hans Michael

AU - Nitschke, Martin

AU - Hoyer, Joachim

AU - Thorban, Stefan

AU - Weinmann-Menke, Julia

AU - Heller, Katharina

AU - Banas, Bernhard

AU - Schwenger, Vedat

AU - Nadalin, Silvio

AU - Lopau, Kai

AU - Hüser, Norbert

AU - Heemann, Uwe

PY - 2020/6/1

Y1 - 2020/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85078829456&partnerID=8YFLogxK

U2 - 10.1111/tri.13569

DO - 10.1111/tri.13569

M3 - Journal articles

C2 - 31903658

AN - SCOPUS:85078829456

SN - 0934-0874

VL - 33

SP - 617

EP - 631

JO - Transplant International

JF - Transplant International

IS - 6

ER -

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

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