by Katy Trébern-Launay, Yohann Foucher, Magali Giral, Christophe Legendre, Henri Kreis, Michèle Kessler, Marc Ladrière, Nassim Kamar, Lionel Rostaing, Valérie Garrigue, Georges Mourad, Emmanuel Morelon, Jean-Paul Soulillou, Jacques Dantal
Old studies reported a worse outcome for second transplant recipient (STR) than for first transplant recipient (FTR) mainly due to non-comparable populations with numbers confounding factors. More recent analysis, based on improved methodology by using multivariate regressions, challenged this generally accepted idea: the poor prognosis for STR is still under debate. Methodology
To assess the long-term patient-and-graft survival of STR compared to FTR, we performed an observational study based on the French DIVAT prospective cohort between 1996 and 2010 (N?=?3103 including 641 STR). All patients were treated with a CNI, an mTOR inhibitor or belatacept in addition to steroids and mycophenolate mofetil for maintenance therapy. Patient-and-graft survival and acute rejection episode (ARE) were analyzed using Cox models adjusted for all potential confounding factors such as pre-transplant anti-HLA immunization. Results
We showed that STR have a higher risk of graft failure than FTR (HR?=?2.18, p?=?0.0013) but that this excess risk was observed after few years of transplantation. There was no significant difference between STR and FTR in the occurrence of either overall ARE (HR?=?1.01, p?=?0.9675) or steroid-resistant ARE (HR?=?1.27, p?=?0.4087). Conclusions
The risk of graft failure following second transplantation remained consistently higher than that observed in first transplantation after adjusting for confounding factors. The rarely performed time-dependent statistical modeling may explain the heterogeneous conclusions of the literature concerning second transplantation outcomes. In clinical practice, physicians should not consider STR and FTR equally.