Abstract: TH-PO729
Kidney Allograft Nephrectomy Is Associated with Lower Mortality and Improved Repeat Kidney Transplant Rates
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Achinger, Steven, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
- Ayus, Juan Carlos, University of California Irvine, Irvine, California, United States
- Kumar, Ambuj, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
- Tsalatsanis, Athanasios, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
Background
It has been shown that surgical removal of failed allografts leads to both reduced inflammatory markers and improved patient survival. However, the potential impact of allograft nephrectomy on repeat transplantation is unknown.
Methods
We performed a retrospective cohort study using USRDS data where adult patients with Medicare coverage returning to dialysis after failed kidney transplant between January 1, 1995, and December 31, 2018 were eligible. The index event for the analysis in the comparison group was the date of failure of the first renal allograft. The index event for the analysis in the nephrectomy group was the date of nephrectomy. The primary outcome was time to second transplant. We extracted data on demographics, insurance status and Charlson comorbidity index (using 3 years of hospital claims preceding index event). All analyses were performed using R 4.0.3 package.
Results
Overall, 48,094 patients met the inclusion criteria and 10,117 patients had an allograft nephrectomy. After propensity score matching, 10,117 patients each remained in the nephrectomy and comparison cohorts (Table 1). Patients in the nephrectomy cohort were more likely to receive a second transplant than patients in the comparison group (HR 1.13; 95% CI:1.07, 1.20; p<0.001) (Figure 1). At 2 , 5 and 10 years follow-up, the nephrectomy group had a reduced likelihood of death and a higher likelihood of being alive and having a functional kidney allograft than the comparison group.
Conclusion
Allograft nephrectomy is associated with higher likelihood of repeat kidney transplantation and long term survival with a functioning kidney allograft compared with propensity score matched patients without allograft nephrectomy.