Dialysis – Transplantation
Kidney International (2003) 64, 674–680; doi:10.1046/j.1523-1755.2003.00104.x
Ten-year survival of second kidney transplants: Impact of immunologic factors and renal function at 12 months
Stéphanie Coupel, Magali Giral-Classe, Georges Karam, Jean-François Morcet, Jacques Dantal, Diego Cantarovich, Gilles Blancho, Jean-Denis Bignon, Pascal Daguin, Jean-Paul Soulillou and Maryvonne Hourmant
ITERT—Institut de Transplantation et de Recherche en Transplantation—and INSERM U437, Immunointervention en Allo et Xénotransplantations, Nantes, France; Service d'Urologie, CHU Hôtel-Dieu, Nantes, France; Unité de Statistiques, INSERM, Nantes, France; and Laboratoire d'Histocompatibilité, Etablissement Français du Sang, Nantes, France
Correspondence: Stéphanie Coupel, M.D., ITERT—Institut de Transplantation et de Recherche en Transplantation—and INSERM U437, Immunointervention en Allo et Xénotransplantations, 30, Bd Jean Monnet, 44093 Nantes, cedex 01, France. E-mail: stephanie.coupel@chu-nantes.fr
Received 15 November 2002; Revised 3 March 2003; Accepted 21 March 2003.
Abstract
Ten-year survival of second kidney transplants: Impact of immunologic factors and renal function at 12 months.
Background
The aim of the present study was to assess long-term survival of cadaveric second kidney allografts performed in our center and to determine risk factors predictive of long-term graft outcome.
Methods
Of 1704 kidney transplantations performed between January 1985 and March 1998, 233 were second grafts. The majority of the recipients were sensitized. All patients were treated with the same quadruple immunosuppressive regimen.
Results
Kaplan-Meier analysis documented graft survival of 89% at 1 year, 76% at 5 years, and 53% at 10 years. Graft survival was similar for second and primary kidney transplants performed during the same period of time. When long-term second graft survival was examined, only two risk factors were found to be significant: (1) the degree of human leukocyte antigen (HLA) DR mismatch (MM) and (2) the number of acute rejection episodes. Multivariate analysis of several pre- and posttransplant variables also confirmed the importance of HLA MM (DR> A), but also, identified serum creatinine at 12 months as the most significant predictor of graft survival. In addition, the Cox proportional hazards model revealed that only the year of transplantation had an independent significant effect on acute rejection occurrence (RR = 0.591, 95%CI 0.437 to 0.801, P < 0.0007). Indeed, the incidence of acute rejection was found to decrease over time (44% of patients experienced at least one episode of acute rejection before 1990 vs. 17% after 1990).
Conclusion
Finally, second graft long-term outcome shows an improved evolution according to the time period resulting from a strong decrease in acute rejection incidence and the impact of creatinine at 12 months.
Keywords:
second graft, kidney, long-term survival, acute rejection, HLA matching, 1-year creatinine
