Transplant Nephrectomy - Improved Survival in Patients with Failed Allograft

Published ahead of print on November 19, 2009
Journal of the American Society of Nephrology
© 2009 American Society of Nephrology
doi: 10.1681/ASN.2009050480
Transplant Nephrectomy Associates with Improved Survival in Patients with Failed Renal Allograft

Juan Carlos Ayus*, Steven G. Achinger{dagger}, Shuko Lee{ddagger}, Mohamed H. Sayegh§ and Alan S. Go||¶

* Department of Clinical Research, Renal Consultants of Houston, Houston, Texas;
{dagger} Physicians Clinical Research, San Antonio, Texas;
{ddagger} Veterans Administration Hospital, San Antonio, Texas;
§ Transplantation Research Center, Renal Division, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts;
|| Division of Research, Kaiser Permanente of Northern California, Oakland, California; and
¶ Departments of Epidemiology, Biostatistics, and Medicine, University of California at San Francisco, San Francisco, California

Correspondence: Dr. Juan Carlos Ayus, Department of Clinical Research, Renal Consultants of Houston, 2412 Westgate Street, Houston, TX. Phone: 713-502-0543; Fax: 713-942-9342; E-mail: carlosayus@yahoo.com

Received for publication May 5, 2009. Accepted for publication August 30, 2009.

There is a growing number of patients returning to dialysis after a failed kidney transplant, and there is increasing evidence of higher mortality among this population. Whether removal of the failed renal allograft affects survival while receiving long-term dialysis is not well understood. We identified all adults who received a kidney transplant and returned to long-term dialysis after renal allograft failure between January 1994 and December 2004 from the US Renal Data System. Among 10,951 transplant recipients who returned to long-term dialysis, 3451 (31.5%) received an allograft nephrectomy during follow-up. Overall, 34.6% of these patients died during follow-up. Receiving an allograft nephrectomy associated with a 32% lower adjusted relative risk for all-cause death (adjusted hazard ratio 0.68; 95% confidence interval 0.63 to 0.74) after adjustment for sociodemographic characteristics, comorbidity burden, donor characteristics, interim clinical conditions associated with receiving allograft nephrectomy, and propensity to receive an allograft nephrectomy. In conclusion, within a large, nationally representative sample of high-risk patients returning to long-term dialysis after failed kidney transplant, receipt of allograft nephrectomy independently associated with improved survival.

http://jasn.asnjournals.org/cgi/content/abstract/ASN.2009050480v2