Predictors of graft function and survival in second kidney transplantation: A single center experience

BACKGROUND The increasing kidney retransplantation rate has created a parallel field of research,including the risk factors and outcomes of this advanced form of renal replacement therapy.The presentation of experiences from different kidney transplantation centers may help enrich the literature on kidney retransplantation,as a specific topic in the field of kidney transplantation.AIM To identify the risk factors affecting primary graft function and graft survival rates after second kidney transplantation(SKT).METHODS The records of SKT cases performed between January 1977 and December 2014 at a European tertiary-level kidney transplantation center were retrospectively reviewed and analyzed.Beside the descriptive characteristics,the survivals of patients and both the first and second grafts were described using Kaplan-Meier curves.In addition,Kaplan-Meier analyses were also used to estimate the survival probabilities at 1,3,5,and 10 post-operative years,as well as at the longest followup duration available.Moreover,bivariate associations between various predictors and the categorical outcomes were assessed,using the suitable biostatistical tests,according to the predictor type.RESULTS Out of 1861 cases of kidney transplantation,only 48 cases with SKT were eligible for studying,including 33 men and 15 women with a mean age of 42.1±13 years.The primary non-function(PNF)graft occurred in five patients(10.4%).In bivariate analyses,a high body mass index(P=0.009)and first graft loss due to acute rejection(P=0.025)were the only significant predictors of PNF graft.The second graft survival was reduced by delayed graft function in the first(P=0.008)and second(P<0.001)grafts.However,the effect of acute rejection within the first year after the first transplant did not reach the threshold of significance(P=0.053).The mean follow-up period was 59.8±48.6 mo.Censored graft/patient survival rates at 1,3,5 and 10 years were 90.5%/97.9%,79.9%/95.6%,73.7%/91.9%,and 51.6%/83.0%,respectively.CONCLUSION Non-immediate recovery modes of the first and second graft functions were significantly associated with unfavorable second graft survival rates.Patient and graft survival rates of SKT were similar to those of the first kidney transplantation.

Successful second transplantation from haploidentical donor for graft failure following unrelated cord blood cell transplantation or mismatched related transplantation:2 cases report

Cord blood transplantation （CBT） from unrelated donors has increasingly been performed worldwide during the last decade. The immaturity of lymphocytes in cord blood permits HLA-mismatching between donors and recipients and reduces the severity of graft-versus-host disease （GVHD）. However, the relatively small dose of the cord blood nucleated cells is associated with a high frequency of engraftment failure.15 But re-transplantation with stem cells from the original donor is impossible.

Second unmanipulated allogeneic transplantation could be used as a salvage option for patients with relapsed acute leukemia post-chemotherapy plus modified donor lymphocyte infusion

Relapse is the main problem after allogeneic hematopoietic stem cell transplantation(allo-HSCT).The outcome of a second allo-HSCT(HSCT2)for relapse post-HSCT has shown promising results in some previous studies.However,little is known about the efficacy of HSCT2 in patients with relapsed/refractory acute leukemia(AL)post-chemotherapy plus modified donor lymphocyte infusion(post-Chemo+m-DLI)after the first allo-HSCT(HSCT1).Therefore,we retrospectively analyzed the efficacy of HSCT2 in 28 patients with relapsed/refractory AL post-Chemo+m-DLI in our center.With a median follow-up of 918(457–1732)days,26 patients(92.9%)achieved complete remission,and 2 patients exhibited persistent disease.The probabilities of overall survival(OS)and disease-free survival(DFS)1 year after HSCT2 were 25.0%and 21.4%,respectively.The cumulative incidences of nonrelapse mortality on day 100 and at 1 year post-HSCT2 were 7.1%±4.9%and 25.0%±8.4%.The cumulative incidences of relapse were 50.0%±9.8%and 53.5%±9.9%at 1 and 2 years post-HSCT2,respectively.Risk stratification prior to HSCT1 and percentage of blasts before HSCT2 were independent risk factors for OS post-HSCT2,and relapse within 6 months post-HSCT1 was an independent risk factor for DFS and relapse post-HSCT2.Our findings suggest that HSCT2 could be a salvage option for patients with relapsed AL post-Chemo+m-DLI.