Abstract
Rationale & objective
Risk factors for adverse outcomes after first transplant have been established, but less is known about predictors of risk at the time of retransplant, including the impact of first transplant characteristics. Therefore, in this study, we aimed to examine how first transplant factors may affect subsequent transplant.Study design
Retrospective cohort study.Setting & participants
We analyzed data from adult patients in the United States (Scientific Registry of Transplant Recipients) who underwent second kidney transplant (2000-2017).Exposure
First transplant characteristics (age, human leukocyte antigen match, panel-reactive antibody [PRA], first transplant graft survival time, and time from failure of first transplant).Outcome
Death-censored graft loss (DCGL) after repeat transplant.Analytical approach
Multivariable Cox proportional hazard models.Results
This study included 23,688 patients who underwent repeat transplant. DCGL risk was increased for patients with higher PRA at first transplant (adjusted HR [aHR], 1.16; 95% CI, 1.00-1.34 for PRA >80% vs 7 years [relative to survival time 1 month-1 year]). Human leukocyte antigen mismatch at first transplant was not significantly associated with DCGL at retransplant.Limitations
Potential for selection bias; patients who died before retransplant or became ineligible for repeat transplant were excluded.Conclusions
First transplant PRA >80%, age 18-30 years, time between a first transplant failing and retransplant, and first transplant survival duration are significantly associated with DCGL at kidney retransplantation.