title: Ten-year survival of second kidney transplants: impact of immunologic factors and renal function at 12 months.
abstract: BACKGROUND
  The aim of the present study was to assess long-term survival of cadaveric second kidney allografts performed in our center and to determine risk factors predictive of long-term graft outcome.
  
  
  METHODS
  Of 1704 kidney transplantations performed between January 1985 and March 1998, 233 were second grafts. The majority of the recipients were sensitized. All patients were treated with the same quadruple immunosuppressive regimen.
  
  
  RESULTS
  Kaplan-Meier analysis documented graft survival of 89% at 1 year, 76% at 5 years, and 53% at 10 years. Graft survival was similar for second and primary kidney transplants performed during the same period of time. When long-term second graft survival was examined, only two risk factors were found to be significant: (1) the degree of human leukocyte antigen (HLA) DR mismatch (MM) and (2) the number of acute rejection episodes. Multivariate analysis of several pre- and posttransplant variables also confirmed the importance of HLA MM (DR> A), but also, identified serum creatinine at 12 months as the most significant predictor of graft survival. In addition, the Cox proportional hazards model revealed that only the year of transplantation had an independent significant effect on acute rejection occurrence (RR = 0.591, 95%CI 0.437 to 0.801, P < 0.0007). Indeed, the incidence of acute rejection was found to decrease over time (44% of patients experienced at least one episode of acute rejection before 1990 vs. 17% after 1990).
  
  
  CONCLUSIONS
  Finally, second graft long-term outcome shows an improved evolution according to the time period resulting from a strong decrease in acute rejection incidence and the impact of creatinine at 12 months.
authors.affiliation: Institut de Transplantation et de Recherche en Transplantation and INSERM U437, Immunointervention en Allo et Xénotransplantations, Nantes, France. stephanie.coupel@chu-nantes.fr
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Coupel
authors.forename: Magali
authors.initials: M
authors.lastname: Giral-Classe
authors.forename: Georges
authors.initials: G
authors.lastname: Karam
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Morcet
authors.forename: Jacques
authors.initials: J
authors.lastname: Dantal
authors.forename: Diego
authors.initials: D
authors.lastname: Cantarovich
authors.forename: Gilles
authors.initials: G
authors.lastname: Blancho
authors.forename: Jean-Denis
authors.initials: JD
authors.lastname: Bignon
authors.forename: Pascal
authors.initials: P
authors.lastname: Daguin
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Soulillou
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Hourmant
mesh_terms: D000208:Acute Disease; D000328:Adult; D002102:Cadaver; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000401:mortality*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012086:Reoperation / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis