Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation - Multivariate analyses from the United States Renal Data System

Background, Survival of transplant recipients after primary renal allograft failure has not been well studied, Methods. A cohort of 19,208 renal transplant recipients with primary allogr aft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996, The mortali ty, wait-listing, and repeat transplantation rates were assessed. The morta lity risks associated with repeat transplantation were estimated with a tim e-dependent survival model. Results. In total, 34.5% (n=6,631) of patients died during follow-up. Of th ese deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients, Before repeat transplanta tion, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal diseas e, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Amer icans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other rac es, respectively (P<0.0001 each). Repeat transplantation was associated wit h 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic e nd-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. Conclusions. The loss of a primary renal allograft was associated with sign ificant mortality, especially in recipients with type I DM. Repeat transpla ntation was associated with a substantial improvement in 5-year patient sur vival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.