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Raj Kiran Medapalli, MD, MPH.  Nephrology Fellow January 5 th  2011 Mount Sinai School of Medicine Division of Nephrology Journal Club
Transplant Nephrectomy Improves Survival following a Failed Renal Allograft . JASN 21: 374–380, 2010. Journal Club  January 5 th  2011 Raj Kiran Medapalli, MD, MPH.
Failed renal allograft - Disease burden ,[object Object],[object Object],[object Object]
Prognosis after failed primary renal allograft ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Death after primary renal allograft loss 78564 pts who underwent primary renal transplant  between 1988-1998; 10 yr follow-up. USRDS In comparison, annual death rate on renal transplant waiting list is  6.33% per 100-pt-years (9.27% for diabetics) Annual adjusted death rates per 100 pt-years Death with functioning transplant Death after graft loss N Annual rate % N Annual rate % Overall 10816 2.81 4712 9.42 Cardio-vasc 3402 0.69 2252 4.31 Infectious 1856 0.37 879 1.63 Malignancy 808 0.19 122 0.11
Source: Kaplan and Meier-Kriesche. AJT 2002; 2: 970-74
Potential explanations for high mortality in patients with allograft failure ,[object Object],[object Object],[object Object]
Allograft nephrectomy after transplant failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Allograft nephrectomy after transplant failure (US)
Allograft nephrectomy & repeat transplantation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Usual indications for transplant nephrectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Withdrawal of immunosuppression after allograft failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Study Design - 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Study Design - 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Study outcomes & Statistical analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Propensity Scores ,[object Object],[object Object],[object Object],[object Object]
Propensity Scores ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Propensity Scores ,[object Object],[object Object],[object Object],[object Object],[object Object]
Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
b Defined as need for dialysis before hospital discharge after transplantation.
 
d Coded during any hospitalization occurring after return to dialysis after failed kidney transplant.
 
Unadjusted Rates (1994-2004) All-cause mortality Total N=10,951 32 vs. 36 per 100 Person Years (p=0.0324) Repeat transplantation Total N=10,951  10% vs. 4.1% (p<0.001)
Adjusted for : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adjusted rates + Sensitivity Analysis
Results summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
Study strengths ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Study weaknesses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
My Conclusions - 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],My Conclusions - 2
My conclusions - 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]

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Transplant Nephrectomy Improves Survival following a Failed Renal Allograft (Journal Club)

  • 1. Raj Kiran Medapalli, MD, MPH. Nephrology Fellow January 5 th 2011 Mount Sinai School of Medicine Division of Nephrology Journal Club
  • 2. Transplant Nephrectomy Improves Survival following a Failed Renal Allograft . JASN 21: 374–380, 2010. Journal Club January 5 th 2011 Raj Kiran Medapalli, MD, MPH.
  • 3.
  • 4.
  • 5. Death after primary renal allograft loss 78564 pts who underwent primary renal transplant between 1988-1998; 10 yr follow-up. USRDS In comparison, annual death rate on renal transplant waiting list is 6.33% per 100-pt-years (9.27% for diabetics) Annual adjusted death rates per 100 pt-years Death with functioning transplant Death after graft loss N Annual rate % N Annual rate % Overall 10816 2.81 4712 9.42 Cardio-vasc 3402 0.69 2252 4.31 Infectious 1856 0.37 879 1.63 Malignancy 808 0.19 122 0.11
  • 6. Source: Kaplan and Meier-Kriesche. AJT 2002; 2: 970-74
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.  
  • 14.
  • 15.  
  • 16.  
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.  
  • 24.  
  • 25. b Defined as need for dialysis before hospital discharge after transplantation.
  • 26.  
  • 27. d Coded during any hospitalization occurring after return to dialysis after failed kidney transplant.
  • 28.  
  • 29. Unadjusted Rates (1994-2004) All-cause mortality Total N=10,951 32 vs. 36 per 100 Person Years (p=0.0324) Repeat transplantation Total N=10,951 10% vs. 4.1% (p<0.001)
  • 30.
  • 31. Adjusted rates + Sensitivity Analysis
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.