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A multi-factor analysis of kidney regraft outcomes.
Clin Transpl. 2002CT

Abstract

1. GENERAL: We updated prior analyses of renal retransplants reported to the UNOS Registry by estimating the compound effects of 22 covariates on regraft survival within 2 consecutive posttransplant risk periods. During an early risk period, 9,126 kidney-only regraft recipients were followed through one year, and, in a second risk period, 7,798 recipients whose regrafts survived beyond one year were followed for 5 years posttransplant. The study sample represented a unique set of patients whose first renal transplants were also recorded by the registry. 2. RELATIVE INFLUENCE OF TRANSPLANT FACTORS AND CENTER: From a multivariate log-linear analysis, the top 5 factors influencing one-year regraft survival rates were ranked as follows: 1) transplant center (accounted for 24% of the variation in short-term outcomes); 2) duration of first graft (19%); 3) donor age (15%); 4) recipient's body mass index (7%); and 5) year of transplant (6%). Ranking long-term outcomes demonstrated that donor age was the dominant factor governing the 5-year survival rates among regrafts, accounting for 30% of long-term variation. Transplant center, recipient age and race, and donor relationship accounted for another 16%, 14%, 10% and 8% of changes in long-term regraft survival, respectively. Despite center effects, a center's volume did not appear to be associated with outcome, and a center's short-term effect did not predict its long-term results, as the correlation between one- and 5-year center-specific rates was small (R = 0.11) and statistically insignificant (P = 0.15). 3. RECIPIENT FACTORS RELATED TO FIRST TRANSPLANT: Among 4 recipient factors related to a first transplant, only the first graft's survival duration significantly influenced both short- and long-term outcomes of regrafts. If the first graft survived for more than 2 years, a regraft had an approximate 90% chance of surviving to one year as compared with an 80% chance if the first graft failed within 2 years. Regrafts among recipients whose first graft lasted more than 4 3/4 years exhibited better 5-year survival rates (82.2%) versus the less-than-average rates for the other groups. 4. RECIPIENT FACTORS: Six of the 7 recipient factors selected for analysis significantly influenced short- or long-term regraft outcomes: 1) female recipients had significantly higher long-term regraft survival rates; 2) Black recipients of regrafts had poor long-term results; 3) children (0-12 yr) exhibited markedly diminished one-year regraft survival rates, and teenage recipients exhibited poor long-term regraft function; 4) obese recipients (body mass index > 30 kg/m2) had poor one-year and 5-year regraft survival rates; 5) impaired functional status immediately pre-retransplant significantly reduced both short- and long-term rates; and 6) regraft recipients whose PRA was above 0% exhibited diminished one-year and 5-year regraft survival rates. 5. DONOR FACTORS: Regraft recipients receiving a living donor's kidney had 87% one-year graft survival, outperforming cadaveric regrafts by 8 percentage points during the initial period. At 5 years, survival rates for patients receiving living related (except parents) or unrelated donor regrafts enjoyed above average 5-year survival rates, but parental and cadaver types of donors demonstrated poor long-term values. The strong short-term effect of donor age emanated from poorer regraft functions from both younger and older donors, whereas the long-term effect arose primarily as a result of the poor regraft functions from older donors. After 24 hours of cold ischemia time, early cadaveric regraft survival rates were significantly impaired. 6. TRANSPLANT FACTORS: This study clarified the effects of HLA mismatches and re-exposure to mismatched antigens on regraft survival rates. Generally, receiving a zero mismatched regraft was beneficial. Specifically, class I incompatible regrafts with repeat AB mismatches demonstrated superior long-term rates, even surpassing the 5-year results for 0 AB mismatches. Incompatible class II regrafts with re-exposure to DR antigens had marginal reductions in short- and long-term outcomes. Increasing numbers of HLA-AB mismatches did not seriously impact regraft survival, but any DR mismatch seriously reduced the one-year regraft survival rate.

Authors+Show Affiliations

UCLA Immunogenetics Center, Department of Pathology, University of California Los Angeles, Los Angeles, California, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12971460

Citation

Gjertson, David W.. "A Multi-factor Analysis of Kidney Regraft Outcomes." Clinical Transplants, 2002, pp. 335-49.
Gjertson DW. A multi-factor analysis of kidney regraft outcomes. Clin Transpl. 2002.
Gjertson, D. W. (2002). A multi-factor analysis of kidney regraft outcomes. Clinical Transplants, 335-49.
Gjertson DW. A Multi-factor Analysis of Kidney Regraft Outcomes. Clin Transpl. 2002;335-49. PubMed PMID: 12971460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multi-factor analysis of kidney regraft outcomes. A1 - Gjertson,David W, PY - 2003/9/16/pubmed PY - 2003/10/24/medline PY - 2003/9/16/entrez SP - 335 EP - 49 JF - Clinical transplants JO - Clin Transpl N2 - 1. GENERAL: We updated prior analyses of renal retransplants reported to the UNOS Registry by estimating the compound effects of 22 covariates on regraft survival within 2 consecutive posttransplant risk periods. During an early risk period, 9,126 kidney-only regraft recipients were followed through one year, and, in a second risk period, 7,798 recipients whose regrafts survived beyond one year were followed for 5 years posttransplant. The study sample represented a unique set of patients whose first renal transplants were also recorded by the registry. 2. RELATIVE INFLUENCE OF TRANSPLANT FACTORS AND CENTER: From a multivariate log-linear analysis, the top 5 factors influencing one-year regraft survival rates were ranked as follows: 1) transplant center (accounted for 24% of the variation in short-term outcomes); 2) duration of first graft (19%); 3) donor age (15%); 4) recipient's body mass index (7%); and 5) year of transplant (6%). Ranking long-term outcomes demonstrated that donor age was the dominant factor governing the 5-year survival rates among regrafts, accounting for 30% of long-term variation. Transplant center, recipient age and race, and donor relationship accounted for another 16%, 14%, 10% and 8% of changes in long-term regraft survival, respectively. Despite center effects, a center's volume did not appear to be associated with outcome, and a center's short-term effect did not predict its long-term results, as the correlation between one- and 5-year center-specific rates was small (R = 0.11) and statistically insignificant (P = 0.15). 3. RECIPIENT FACTORS RELATED TO FIRST TRANSPLANT: Among 4 recipient factors related to a first transplant, only the first graft's survival duration significantly influenced both short- and long-term outcomes of regrafts. If the first graft survived for more than 2 years, a regraft had an approximate 90% chance of surviving to one year as compared with an 80% chance if the first graft failed within 2 years. Regrafts among recipients whose first graft lasted more than 4 3/4 years exhibited better 5-year survival rates (82.2%) versus the less-than-average rates for the other groups. 4. RECIPIENT FACTORS: Six of the 7 recipient factors selected for analysis significantly influenced short- or long-term regraft outcomes: 1) female recipients had significantly higher long-term regraft survival rates; 2) Black recipients of regrafts had poor long-term results; 3) children (0-12 yr) exhibited markedly diminished one-year regraft survival rates, and teenage recipients exhibited poor long-term regraft function; 4) obese recipients (body mass index > 30 kg/m2) had poor one-year and 5-year regraft survival rates; 5) impaired functional status immediately pre-retransplant significantly reduced both short- and long-term rates; and 6) regraft recipients whose PRA was above 0% exhibited diminished one-year and 5-year regraft survival rates. 5. DONOR FACTORS: Regraft recipients receiving a living donor's kidney had 87% one-year graft survival, outperforming cadaveric regrafts by 8 percentage points during the initial period. At 5 years, survival rates for patients receiving living related (except parents) or unrelated donor regrafts enjoyed above average 5-year survival rates, but parental and cadaver types of donors demonstrated poor long-term values. The strong short-term effect of donor age emanated from poorer regraft functions from both younger and older donors, whereas the long-term effect arose primarily as a result of the poor regraft functions from older donors. After 24 hours of cold ischemia time, early cadaveric regraft survival rates were significantly impaired. 6. TRANSPLANT FACTORS: This study clarified the effects of HLA mismatches and re-exposure to mismatched antigens on regraft survival rates. Generally, receiving a zero mismatched regraft was beneficial. Specifically, class I incompatible regrafts with repeat AB mismatches demonstrated superior long-term rates, even surpassing the 5-year results for 0 AB mismatches. Incompatible class II regrafts with re-exposure to DR antigens had marginal reductions in short- and long-term outcomes. Increasing numbers of HLA-AB mismatches did not seriously impact regraft survival, but any DR mismatch seriously reduced the one-year regraft survival rate. SN - 0890-9016 UR - https://www.unboundmedicine.com/medline/citation/12971460/A_multi_factor_analysis_of_kidney_regraft_outcomes_ L2 - https://medlineplus.gov/kidneytransplantation.html DB - PRIME DP - Unbound Medicine ER -