Year: 2025
Type: article
Study design: Observational Study
Abstract: Rationale & Objective Allograft failure has been associated with chronic inflammation and poor survival among dialysis patients after allograft failure. Allograft nephrectomy is associated with higher levels of anti-human alloantibodies, making it more difficult to find matching kidney donors; however, the rate of repeat transplantation following allograft nephrectomy is largely unknown. Study Design A retrospective, propensity score-matched cohort study. Setting & Participants Using the US Renal Data System, we identified adult dialysis patients after a failed kidney transplant between January 1, 1995, and December 31, 2015. A total of 50,217 patients met the inclusion criteria. Exposure Kidney allograft nephrectomy Outcomes Primary outcome was repeat kidney transplantation. Analytical Approach Exposure to nephrectomy was modeled as a time-varying event. We estimated the cumulative incidence of repeat kidney transplant using the competing risk approach. After propensity score matching, 9,696 patients remained in each cohort. Results Overall, patients with nephrectomy had higher chances of receiving a second transplant (subdistribution HR, 1.21; 95% CI, 1.15-1.28; P < 0.001). The cumulative incidence of second transplant in the nephrectomy group was 19%, 28%, and 31% at 5, 10, and 20 years, respectively, versus 16%, 24%, and 27% in the comparison group. Limitations As a retrospective, registry-based study, cause and effect relationship cannot be established. Conclusions Allograft nephrectomy of a failed kidney allograft is associated with a higher likelihood of repeat transplantation and should not be considered contraindicated in dialysis patients who are candidates for repeat transplantation. Plain-Language Summary Patients who start dialysis after a failure of kidney transplant have a high risk of dying. Prior studies have shown that removing the failed kidney may help these patients. This procedure is often not performed; however, out of concern that it may be more difficult to match for a repeat kidney transplant if the failed kidney is removed. Our study shows that patients who have a failed kidney transplant removed have a likelihood of repeat transplant. Therefore, removing a failed kidney should not be considered contraindicated in those hoping for a future kidney transplant.
Source: Kidney Medicine
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,590
OpenAlex ID: W4415536084