PMID- 12846765
OWN - NLM
STAT- MEDLINE
DCOM- 20040326
LR  - 20211203
IS  - 0085-2538 (Print)
IS  - 0085-2538 (Linking)
VI  - 64
IP  - 2
DP  - 2003 Aug
TI  - Ten-year survival of second kidney transplants: impact of immunologic factors and 
      renal function at 12 months.
PG  - 674-80
AB  - 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.
FAU - Coupel, Stephanie
AU  - Coupel S
AD  - Institut de Transplantation et de Recherche en Transplantation and INSERM U437, 
      Immunointervention en Allo et Xenotransplantations, Nantes, France. 
      stephanie.coupel@chu-nantes.fr
FAU - Giral-Classe, Magali
AU  - Giral-Classe M
FAU - Karam, Georges
AU  - Karam G
FAU - Morcet, Jean-Francois
AU  - Morcet JF
FAU - Dantal, Jacques
AU  - Dantal J
FAU - Cantarovich, Diego
AU  - Cantarovich D
FAU - Blancho, Gilles
AU  - Blancho G
FAU - Bignon, Jean-Denis
AU  - Bignon JD
FAU - Daguin, Pascal
AU  - Daguin P
FAU - Soulillou, Jean-Paul
AU  - Soulillou JP
FAU - Hourmant, Maryvonne
AU  - Hourmant M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Cadaver
MH  - Female
MH  - Graft Rejection/immunology/mortality
MH  - *Graft Survival
MH  - Humans
MH  - Immunosuppression Therapy
MH  - Kidney/physiology
MH  - Kidney Failure, Chronic/immunology/*mortality
MH  - Kidney Transplantation/*mortality
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Predictive Value of Tests
MH  - Reoperation/*mortality
MH  - Risk Factors
MH  - Survival Analysis
EDAT- 2003/07/09 05:00
MHDA- 2004/03/27 05:00
CRDT- 2003/07/09 05:00
PHST- 2003/07/09 05:00 [pubmed]
PHST- 2004/03/27 05:00 [medline]
PHST- 2003/07/09 05:00 [entrez]
AID - S0085-2538(15)49376-7 [pii]
AID - 10.1046/j.1523-1755.2003.00104.x [doi]
PST - ppublish
SO  - Kidney Int. 2003 Aug;64(2):674-80. doi: 10.1046/j.1523-1755.2003.00104.x.