Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2023; 13(6): 331-343
Published online Dec 18, 2023. doi: 10.5500/wjt.v13.i6.331
Predictors of graft function and survival in second kidney transplantation: A single center experience
Mahmoud Khalil, Rabea Ahmed Gadelkareem, Medhat Ahmed Abdallah, Mohamed Abdel-Basir Sayed, Fathy Gaber Elanany, Paolo Fornara, Nasreldin Mohammed
Mahmoud Khalil, Rabea Ahmed Gadelkareem, Medhat Ahmed Abdallah, Mohamed Abdel-Basir Sayed, Fathy Gaber Elanany, Nasreldin Mohammed, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Assiut, Egypt
Paolo Fornara, Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale) 71515, Germany
Author contributions: Khalil M and Gadelkareem RA designed the research, collected the data, performed statistical analysis and wrote the paper; Abdallah MA, Mohammed N and Sayed MA contributed to data collection, literature review, writing and revision; and Elanany FG and Fornara P contributed to literature review, writing, revision and supervision of the work; All authors approved the paper.
Institutional review board statement: The authors confirm that all the experimental protocols of this study were approved by the Ethical Committee (Institutional Review Board; IRB) of the Faculty of Medicine, Assiut University, Egypt and Martin-Luther University, Germany (IRB approval number: 17200548/2015).
Informed consent statement: This article is a retrospective study. Hence, the patients were not required to give informed consent to the study, because the manipulated data were anonymous and were obtained after each patient, with his potential kidney donor(s), agreed to the plan of management.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: The data supporting this study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Assiut, Egypt.
Received: August 16, 2023
Peer-review started: August 16, 2023
First decision: September 14, 2023
Revised: October 19, 2023
Accepted: November 3, 2023
Article in press: November 3, 2023
Published online: December 18, 2023
Processing time: 123 Days and 17.4 Hours
Research background

The increasing kidney retransplantation rate has created a parallel field of research, including the risk factors and outcomes of this advanced form of renal replacement therapy. The presentation of experiences from different kidney transplantation (KT) centers may help enrich the literature on kidney retransplantation, as a specific topic in the field of KT.

Research motivation

Despite the potential high risks of repeated KT, increase of the rate of second KT (SKT) seems to be a modifiable variable and may provide better outcomes than return to dialysis in patients with failed first KT.

Research objectives

To identify the risk factors affecting primary graft function and graft survival rates after SKT.

Research methods

The records of SKT cases performed between January 1977 and December 2014 at a European tertiary-level kidney transplantation center were retrospectively reviewed and analyzed. Beside the descriptive characteristics, the survivals of patients and both the first and second grafts were described using Kaplan-Meier curves. In addition, Kaplan-Meier analyses were also used to estimate the survival probabilities at 1, 3, 5, and 10 post-operative years, as well as at the longest follow-up duration available. Moreover, bivariate associations between various predictors and the categorical outcomes were assessed, using the suitable biostatistical tests, according to the predictor type. However, associations with quantitative predictors were evaluated by Cox regression.

Research results

Out of 1861 cases of kidney transplantation, only 48 cases with SKT were eligible for studying, including 33 men and 15 women with a mean age of 42.1 ± 13 years. The primary non-function (PNF) graft occurred in five patients (10.4%). In bivariate analyses, a high body mass index (P = 0.009) and first graft loss due to acute rejection (P = 0.025) were the only significant predictors of PNF graft. The second graft survival was reduced by delayed graft function in the first (P = 0.008) and second (P < 0.001) grafts. However, the effect of acute rejection within the first year after the first transplant did not reach the threshold of significance (P = 0.053). The mean follow-up period was 59.8 ± 48.6 mo. Censored graft/patient survival rates at 1, 3, 5 and 10 years were 90.5%/97.9%, 79.9%/95.6%, 73.7%/91.9%, and 51.6%/83.0%, respectively.

Research conclusions

Non-immediate recovery modes of the first and second graft functions were significantly associated with unfavorable second graft survival rates. Patient and graft survival rates of SKT were similar to those of the first KT.

Research perspectives

Repeated kidney transplantation may provide better outcomes in patients with failed previous grafts. However, this approach may be associated with higher risks than the first time due to the surgical difficulties and immunological sensitization. Controlling of these risk factors can enhance the outcomes.