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Short-term outcomes of second kidney transplantation compared with those of first transplantation in Japanese patients: a single-center, retrospective, observational study

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Abstract

Background

Among patients who undergo kidney transplantation, a subsequent second kidney transplantation (TX2) is often necessary. The TX2 outcomes remain controversial, however, and only limited data are available on clinical outcomes of TX2 in Japanese patients. This study aimed to assess graft and patient survival rates of TX2 and compared these rates with those of first kidney transplantation (TX1) in Japanese patients.

Methods

Of the 898 kidney transplantations performed between 2010 and 2019 at our institution, 33 were TX2. We performed survival analysis using weighted Kaplan–Meier analysis and Cox proportional hazards analysis with propensity score matching, specifically inverse probability of treatment weighting (IPTW).

Results

Death-censored graft survival (DCGS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.3, 97.9, and 95.0% versus 100, 96.0, and 91.2%, respectively. Overall survival (OS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.4, 98.9, and 97.8% versus 100, 100, and 94.4%, respectively. Using the log-rank test, IPTW-weighted Kaplan–Meier curves showed no significant differences for TX1 versus TX2 in DCGS (p = 0.535) and OS (p = 0.302). On Cox proportional hazards analysis for TX2 versus TX1, the IPTW-adjusted hazard ratio (HR) for DCGS was 1.75 (95% CI, 0.28–10.9; p = 0.550) and for OS was 2.71 (95% CI, 0.40–18.55; p = 0.311).

Conclusions

For patients who require TX2, this treatment is an acceptable option based on the short-term outcomes data for DCGS and OS.

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Acknowledgements

The authors thank Enago (https://www.enago.com) for English language editing; and Hajime Yamakage (Satista, Co., Ltd.) for statistical advice.

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Authors and Affiliations

  1. Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan

    Hiroki Fukuhara, Takaaki Nawano, Akiko Kanda, Toshihide Tomosugi, Manabu Okada, Kenta Futamura, Takahisa Hiramitsu, Norihiko Goto, Shunji Narumi & Yoshihiko Watarai

  2. Department of Nephrology, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan

    Asami Takeda

  3. Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan

    Hiroki Fukuhara & Norihiko Tsuchiya

Authors
  1. Hiroki Fukuhara
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  2. Takaaki Nawano
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  4. Toshihide Tomosugi
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Contributions

Yoshihiko Watarai and Shunji Narumi designed the study. Hiroki Fukuhara and Asami Takeda performed the research. Hiroki Fukuhara wrote the manuscript. Hiroki Fukuhara, Takaaki Nawano, and Akiko Kanda analyzed and interpreted patient data. Toshihide Tomosugi, Manabu Okada, Kenta Futamura, Takahisa Hiramitsu, Norihiko Tsuchiya, Norihiko Goto, and Shunji Narumi provided methodological advice on study design. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Hiroki Fukuhara.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All the procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 1393S) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Because the data were anonymized, the requirement for informed consent was waived by the institutional ethics committee.

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Fukuhara, H., Nawano, T., Kanda, A. et al. Short-term outcomes of second kidney transplantation compared with those of first transplantation in Japanese patients: a single-center, retrospective, observational study. Clin Exp Nephrol 27, 188–196 (2023). https://doi.org/10.1007/s10157-022-02290-1

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