RATIONALE & OBJECTIVE The management and outcomes of kidney transplant recipients have evolved over the past three decades. This study of U.S patients whose first kidney allograft failed sought to understand long-term trends in subsequent waitlisting, re-transplantation, and all-cause mortality. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Patients recorded in the United States Renal Data System (USRDS) whose first kidney allograft failed between 1990 and 2019. EXPOSURE The 5-year period in which the allograft failure occurred: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014, or 2015-2019. OUTCOMES 1) Waitlisting for re-transplantation, 2) re-transplantation, and 3) all-cause mortality following first allograft failure. ANALYTICAL APPROACH Competing risk survival analyses using the approach described by Fine and Gray were used for the outcomes of waitlisting and re-transplantation. Cox proportional hazards models were used for the outcome of all-cause mortality. RESULTS The absolute number of patients whose allograft failed and started dialysis increased from 3,197 in 1990 to 5,821 in 2019. Compared to 1990-1994, the rate of waitlisting for a second transplant increased with each subsequent 5-year period, peaking between 2005-2009 before decreasing again subsequently. The rate of re-transplantation following allograft failure decreased by 9%, 14%, 18%, 7%, and 11% in the sequential 5-year eras; and the mortality rate was 25% lower in 2015-2019 (HR=0.75, 95% CI, 0.72-0.77) compared to 1990-1994. Women had a reduced rate of waitlisting (HR 0.93, 95% CI 0.91-0.95) and lower rate of re-transplantation (HR 0.93, 95% CI 0.91, 0.95) compared to men. Compared to White patients, African-American and Hispanic patients had significantly lower rates of waitlisting, re-transplantation, and mortality. LIMITATIONS Retrospective data that lacks granular clinical information. CONCLUSIONS During the past three decades, among patients whose first kidney allograft failed and subsequently initiated dialysis, the rates of waitlisting for re-transplantation increased while the rates of re-transplantation and mortality decreased. Race-, ethnicity-, and sex-based disparities in waitlisting and re-transplantation were observed and warrant further investigation.

中文翻译：

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美国首次移植受者同种异体移植肾失败的趋势。


基本原理和目标 肾移植接受者的管理和结果在过去的三十年里已经发生了变化。这项针对首次同种异体肾移植失败的美国患者的研究旨在了解随后等待名单、再移植和全因死亡率的长期趋势。研究设计 回顾性队列研究。地点和参与者 在美国肾脏数据系统（USRDS）中记录的患者，他们的第一次肾脏同种异体移植手术在1990年至2019年之间失败。暴露 同种异体移植失败发生的 5 年期间：1990-1994、1995-1999、2000-2004、2005-2009、2010-2014 或 2015-2019。结果 1） 再移植等待名单，2） 再移植，以及 3） 首次同种异体移植失败后的全因死亡率。分析方法 使用 Fine 和 Gray 描述的方法进行竞争风险生存分析，用于等待名单和再移植的结果。Cox 比例风险模型用于全因死亡率的结果。结果 同种异体移植失败并开始透析的患者绝对人数从 1990 年的 3,197 人增加到 2019 年的 5,821 人。与 1990-1994 年相比，第二次移植的等待名单率在接下来的 5 年期间增加，在 2005-2009 年之间达到顶峰，随后再次下降。同种异体移植失败后再移植率在连续 5 年时代下降了 9% 、 14% 、 18% 、 7% 和 11% ;与 1990-1994 年相比，2015-2019 年的死亡率降低了 25% （HR=0.75,95% CI，0.72-0.77）。与男性相比，女性的等待名单率降低 （HR 0.93， 95% CI 0.91-0.95） 和再移植率降低 （HR 0.93， 95% CI 0.91， 0.95）。 与白人患者相比，非裔美国人和西班牙裔患者的等待名单、再移植率和死亡率显着降低。局限性 缺乏精细临床信息的回顾性数据。结论 在过去的三十年中，在首次同种异体肾移植失败并随后开始透析的患者中，等待再移植的比率增加，而再移植率和死亡率下降。观察到等待名单和再移植中基于种族、民族和性别的差异，需要进一步调查。