Rao PS et al. (2007) Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients. Am J Kidney Dis 49: 294–300

Many patients return to dialysis after renal graft failure, but whether mortality is higher among these patients than among those on the waiting list for a first transplant is unknown. Rao et al. analyzed data from the Scientific Registry of Transplant Recipients and found that overall mortality was 78% higher in patients who had experienced failure of a primary graft than it was in those who had not yet undergone transplantation.

Of the 175,436 patients who were listed for a kidney transplant in the US between 1 January 1995 and 31 December 2004, 86,178 received a primary transplant, and 10,748 of these experienced graft failure and returned to dialysis. Patients who returned to dialysis after graft failure had an adjusted hazard ratio (HR) for death of 1.78 compared with wait-listed candidates (P <0.0001). Presence of diabetes increased the risk of death.

Mortality rates were greatest in the first week after graft failure; the HR for this period was 13.57 compared with primary transplant candidates, declining to 6.92 for the 8–30 day interval and to 1.23 at 1 year. Patients who had returned to dialysis remained at increased risk of death 5 years after graft failure (HR 1.25; P <0.05 for all).

The authors suggest that excision of failed grafts might improve outcome by decreasing levels of C-reactive protein (which has been associated with increased cardiovascular risk) and obviating the need for immunosuppression. The effect of graft nephrectomy is the subject of an ongoing study.