PMID- 25276347
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141003
LR  - 20220318
IS  - 2047-1440 (Print)
IS  - 2047-1440 (Electronic)
IS  - 2047-1440 (Linking)
VI  - 3
DP  - 2014
TI  - Factors influencing survival after kidney transplant failure.
PG  - 18
LID - 10.1186/2047-1440-3-18 [doi]
AB  - BACKGROUND: The failure of a kidney transplant is now a common reason for 
      initiation of dialysis therapy. Kidney transplant recipients commencing dialysis 
      have greater morbidity and mortality than transplant-naive, incident dialysis 
      patients. This study aimed to identify variables associated with survival after 
      graft failure. METHODS: All recipients of first, deceased donor kidney 
      transplants performed in Northern Ireland between 1986 and 2005 who had a 
      functioning graft at 12 months were included (n = 585). Clinical and 
      blood-derived variables (age, gender, primary renal disease, diabetic status, 
      smoking status, human leukocyte antigen (HLA) mismatch, acute rejection episodes, 
      immunosuppression, cardiovascular disease, graft survival, haemoglobin, albumin, 
      phosphate, C reactive protein, estimated glomerular filtration rate (eGFR), rate 
      of eGFR decline, dialysis modality, and access) were collected prospectively and 
      investigated for association with re-transplantation and survival. The 
      association between re-transplantation and survival was explored by modelling 
      re-transplantation as a time-dependent covariate. RESULTS: Median follow-up time 
      was 12.1 years. Recipients with a failing graft (158/585) demonstrated rapid loss 
      of eGFR prior to graft failure, reducing the time available to plan for 
      alternative renal replacement therapy. Median survival after graft failure was 
      3.0 years. In multivariate analysis, age and re-transplantation were associated 
      with survival after graft failure. Re-transplantation was associated with an 88% 
      reduction in mortality. CONCLUSIONS: Optimal management of kidney transplant 
      recipients with failing grafts requires early recognition of declining function 
      and proactive preparation for re-transplantation given the substantial survival 
      benefit this confers. The survival benefit associated with re-transplantation 
      persists after prolonged exposure to immunosuppressive therapy.
FAU - McCaughan, Jennifer A
AU  - McCaughan JA
AD  - Regional Nephrology Unit, Belfast City Hospital, Belfast BT9 7AB, UK ; Nephrology 
      Research Group, Queen's University, Belfast BT9 7AB, UK.
FAU - Patterson, Christopher C
AU  - Patterson CC
AD  - Center for Public Health, Queen's University, Belfast BT12 6BA, UK.
FAU - Maxwell, Alexander P
AU  - Maxwell AP
AD  - Regional Nephrology Unit, Belfast City Hospital, Belfast BT9 7AB, UK ; Nephrology 
      Research Group, Queen's University, Belfast BT9 7AB, UK.
FAU - Courtney, Aisling E
AU  - Courtney AE
AD  - Regional Nephrology Unit, Belfast City Hospital, Belfast BT9 7AB, UK.
LA  - eng
PT  - Journal Article
DEP - 20140924
PL  - England
TA  - Transplant Res
JT  - Transplantation research
JID - 101597592
PMC - PMC4178314
OTO - NOTNLM
OT  - Graft failure
OT  - Kidney transplantation
OT  - Re-transplantation
OT  - Survival
EDAT- 2014/10/03 06:00
MHDA- 2014/10/03 06:01
PMCR- 2014/09/24
CRDT- 2014/10/03 06:00
PHST- 2014/08/19 00:00 [received]
PHST- 2014/09/17 00:00 [accepted]
PHST- 2014/10/03 06:00 [entrez]
PHST- 2014/10/03 06:00 [pubmed]
PHST- 2014/10/03 06:01 [medline]
PHST- 2014/09/24 00:00 [pmc-release]
AID - 2047-1440-3-18 [pii]
AID - 10.1186/2047-1440-3-18 [doi]
PST - epublish
SO  - Transplant Res. 2014 Sep 24;3:18. doi: 10.1186/2047-1440-3-18. eCollection 2014.