Repeat Transplantation Rate of Patients Receiving Dialysis After Allograft Nephrectomy

Allograft failure has been associated with chronic inflammation and poor survival among dialysis patients after allograft failure. Allograft nephrectomy is associated with higher levels of anti-human alloantibodies, making it more difficult to find matching kidney donors; however, the rate of repeat transplantation following allograft nephrectomy is largely unknown.

A retrospective, propensity score-matched cohort study.

Using the US Renal Data System, we identified adult dialysis patients after a failed kidney transplant between January 1, 1995, and December 31, 2015. A total of 50,217 patients met the inclusion criteria.

Kidney allograft nephrectomy.

Primary outcome was repeat kidney transplantation.

Exposure to nephrectomy was modeled as a time-varying event. We estimated the cumulative incidence of repeat kidney transplant using the competing risk approach. After propensity score matching, 9,696 patients remained in each cohort.

Overall, patients with nephrectomy had higher chances of receiving a second transplant (subdistribution HR, 1.21; 95% CI, 1.15-1.28; P < 0.001). The cumulative incidence of second transplant in the nephrectomy group was 19%, 28%, and 31% at 5, 10, and 20 years, respectively, versus 16%, 24%, and 27% in the comparison group.

As a retrospective, registry-based study, cause and effect relationship cannot be established.

Allograft nephrectomy of a failed kidney allograft is associated with a higher likelihood of repeat transplantation and should not be considered contraindicated in dialysis patients who are candidates for repeat transplantation.