Retransplantation may offer greater survival outcomes than dialysis following a failed kidney transplant


As per a clinical study involving more than 2,300 adult patients, a second kidney transplant is likely to offer improved survival outcomes when compared to shifting over to dialysis treatment in people whose first kidney graft has stopped functioning effectively. This is the concluding finding of the study in the Clinical Journal of the American Society of Nephrology (CJASN), which compared both options.

For the study, a team led by Rainer Oberbauer (Medical University of Vienna, Vienna, Austria) analysed data pertaining to 2,346 adults with a failed first kidney transplant who were waitlisted for a second kidney transplant in Austria between 1980 and 2019.

At a 10-year follow-up point, patients who received a second kidney transplant had a longer average survival time compared with those who underwent dialysis while remaining on the transplant waitlist, the researchers found. Specifically, patients who underwent retransplantation lived for an average of 5.8 months longer.

The difference in survival time with retransplantation was lower in patients who had a longer wait time after their first transplant failed, however. At the 10-year follow-up point, patients with a waiting time of less than one year who underwent retransplantation had an average of eight months of additional life, while patients who had a waiting time of eight years before undergoing retransplantation gained 0.1 months of additional life, on average.

“Our data showed that a second transplantation is advantageous regarding gained life years; however, the difference to non-transplanted patients decreases with time on the waiting list,” said Oberbauer. “Nevertheless, patients might have a higher quality of life when transplanted and therefore should get a second transplant if a suitable donor organ is available.”

Oberbauer also stressed that patients with a failed first kidney transplant should be waitlisted immediately if they are fit to undergo a second transplantation.

An accompanying editorial in CJASN from Mohammad Kazem Fallahzadeh and Kelly A Birdwell (both Vanderbilt University Medical Center, Nashville, USA) notes: “If these results are reproduced in imitated trials from other countries, it would signify the importance of decreasing time on the waiting list for second kidney transplant candidates by measures such as expedited work-up and enlistment of patients with failing first kidney transplants before they require dialysis.”


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