Allograft outcome following repeat transplantation of patients with non-adherence-related first kidney allograft failure: a population cohort study

Revathy Manickavasagar, Germaine Wong, Stephen I. Alexander, Anna Francis, Chanel Prestidge, Nicholas G. Larkins, Amelia Le Page, Wai H. Lim

Research output: Contribution to journalArticle

Abstract

Nonadherence is an important risk factor for premature allograft failure after kidney transplantation, but outcomes after re-transplantation remain uncertain. Using data from the Australian and New Zealand Dialysis and Transplant registry, the associations between causes of first allograft failure and acute rejection-related and non-adherence-related allograft failure following re-transplantation were examined using competing risk analyses, treating the respective alternative causes of allograft failure and death with functioning graft as competing events. Fifty-nine of 2450 patients (2%) lost their first allografts from nonadherence. Patients who lost their first kidney allograft from nonadherence were younger at the time of first kidney allograft failure but waited longer for a second allograft (>5 years: 54% vs. 20%, P < 0.001) compared with other causes. Compared with patients who lost their first allograft from causes other than nonadherence, the adjusted subdistribution hazard ratio (HR and 95% CI) for acute rejection-related second allograft failure was 0.58 (0.08, 4.07; P = 0.582) for patients with allograft failure attributed to nonadherence and was 6.30 (1.34, 29.67; P = 0.020) for non-adherence-related second allograft failure. In this cohort of transplant recipients who have received second allografts, first allograft failure secondary to nonadherence was associated with a marginally greater risk of allograft failure attributed to nonadherence in subsequent transplantation.

Original languageEnglish
JournalTransplant International
DOIs
Publication statusPublished - 1 Jan 2019

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Patient Compliance
Renal Insufficiency
Allografts
Cohort Studies
Transplantation
Population
Transplants
New Zealand
Kidney Transplantation
Registries
Dialysis

Cite this

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title = "Allograft outcome following repeat transplantation of patients with non-adherence-related first kidney allograft failure: a population cohort study",
abstract = "Nonadherence is an important risk factor for premature allograft failure after kidney transplantation, but outcomes after re-transplantation remain uncertain. Using data from the Australian and New Zealand Dialysis and Transplant registry, the associations between causes of first allograft failure and acute rejection-related and non-adherence-related allograft failure following re-transplantation were examined using competing risk analyses, treating the respective alternative causes of allograft failure and death with functioning graft as competing events. Fifty-nine of 2450 patients (2{\%}) lost their first allografts from nonadherence. Patients who lost their first kidney allograft from nonadherence were younger at the time of first kidney allograft failure but waited longer for a second allograft (>5 years: 54{\%} vs. 20{\%}, P < 0.001) compared with other causes. Compared with patients who lost their first allograft from causes other than nonadherence, the adjusted subdistribution hazard ratio (HR and 95{\%} CI) for acute rejection-related second allograft failure was 0.58 (0.08, 4.07; P = 0.582) for patients with allograft failure attributed to nonadherence and was 6.30 (1.34, 29.67; P = 0.020) for non-adherence-related second allograft failure. In this cohort of transplant recipients who have received second allografts, first allograft failure secondary to nonadherence was associated with a marginally greater risk of allograft failure attributed to nonadherence in subsequent transplantation.",
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Allograft outcome following repeat transplantation of patients with non-adherence-related first kidney allograft failure : a population cohort study. / Manickavasagar, Revathy; Wong, Germaine; Alexander, Stephen I.; Francis, Anna; Prestidge, Chanel; Larkins, Nicholas G.; Le Page, Amelia; Lim, Wai H.

In: Transplant International, 01.01.2019.

Research output: Contribution to journalArticle

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T1 - Allograft outcome following repeat transplantation of patients with non-adherence-related first kidney allograft failure

T2 - a population cohort study

AU - Manickavasagar, Revathy

AU - Wong, Germaine

AU - Alexander, Stephen I.

AU - Francis, Anna

AU - Prestidge, Chanel

AU - Larkins, Nicholas G.

AU - Le Page, Amelia

AU - Lim, Wai H.

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AB - Nonadherence is an important risk factor for premature allograft failure after kidney transplantation, but outcomes after re-transplantation remain uncertain. Using data from the Australian and New Zealand Dialysis and Transplant registry, the associations between causes of first allograft failure and acute rejection-related and non-adherence-related allograft failure following re-transplantation were examined using competing risk analyses, treating the respective alternative causes of allograft failure and death with functioning graft as competing events. Fifty-nine of 2450 patients (2%) lost their first allografts from nonadherence. Patients who lost their first kidney allograft from nonadherence were younger at the time of first kidney allograft failure but waited longer for a second allograft (>5 years: 54% vs. 20%, P < 0.001) compared with other causes. Compared with patients who lost their first allograft from causes other than nonadherence, the adjusted subdistribution hazard ratio (HR and 95% CI) for acute rejection-related second allograft failure was 0.58 (0.08, 4.07; P = 0.582) for patients with allograft failure attributed to nonadherence and was 6.30 (1.34, 29.67; P = 0.020) for non-adherence-related second allograft failure. In this cohort of transplant recipients who have received second allografts, first allograft failure secondary to nonadherence was associated with a marginally greater risk of allograft failure attributed to nonadherence in subsequent transplantation.

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