Assfalg, Volker ORCID: 0000-0002-6907-5524, Selig, Katharina ORCID: 0000-0003-0717-4567, Tolksdorf, Johanna, van Meel, Marieke, de Vries, Erwin, Ramsoebhag, Anne-Marie, Rahmel, Axel, Renders, Lutz, Novotny, Alexander, Matevossian, Edouard, Schneeberger, Stefan, Rosenkranz, Alexander R., Berlakovich, Gabriela, Ysebaert, Dirk, Knops, Noel ORCID: 0000-0001-5743-0966, Kuypers, Dirk, Weekers, Laurent, Muehlfeld, Anja, Rump, Lars-Christian, Hauser, Ingeborg, Pisarski, Przemyslaw, Weimer, Rolf, Fornara, Paolo, Fischer, Lutz, Kliem, Volker, Sester, Urban, Stippel, Dirk ORCID: 0000-0002-1107-0907, Arns, Wolfgang, Hau, Hans-Michael, Nitschke, Martin, Hoyer, Joachim, Thorban, Stefan, Weinmann-Menke, Julia, Heller, Katharina, Banas, Bernhard, Schwenger, Vedat, Nadalin, Silvio, Lopau, Kai, Hueser, Norbert and Heemann, Uwe (2020). Repeated kidney re-transplantation-the Eurotransplant experience: a retrospective multicenter outcome analysis. Transpl. Int., 33 (6). S. 617 - 632. HOBOKEN: WILEY. ISSN 1432-2277

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Abstract

In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re-transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15-year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re-DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and >= 4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re-DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re-DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for >= 4th DDRT.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Assfalg, VolkerUNSPECIFIEDorcid.org/0000-0002-6907-5524UNSPECIFIED
Selig, KatharinaUNSPECIFIEDorcid.org/0000-0003-0717-4567UNSPECIFIED
Tolksdorf, JohannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Meel, MariekeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Vries, ErwinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ramsoebhag, Anne-MarieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rahmel, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Renders, LutzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Novotny, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matevossian, EdouardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneeberger, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosenkranz, Alexander R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Berlakovich, GabrielaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ysebaert, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knops, NoelUNSPECIFIEDorcid.org/0000-0001-5743-0966UNSPECIFIED
Kuypers, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weekers, LaurentUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muehlfeld, AnjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rump, Lars-ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hauser, IngeborgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pisarski, PrzemyslawUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weimer, RolfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fornara, PaoloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fischer, LutzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kliem, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sester, UrbanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stippel, DirkUNSPECIFIEDorcid.org/0000-0002-1107-0907UNSPECIFIED
Arns, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hau, Hans-MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nitschke, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoyer, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thorban, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weinmann-Menke, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heller, KatharinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Banas, BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwenger, VedatUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nadalin, SilvioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lopau, KaiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hueser, NorbertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heemann, UweUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-348009
DOI: 10.1111/tri.13569
Journal or Publication Title: Transpl. Int.
Volume: 33
Number: 6
Page Range: S. 617 - 632
Date: 2020
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 1432-2277
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
GRAFT LOSS; COMPETING RISKS; SINGLE-CENTER; 3RD; ALLOCATION; SURVIVAL; 2ND; RECIPIENTS; 1ST; SUCCESSMultiple languages
Surgery; TransplantationMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/34800

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