A meta-analysis of graft survival, patient survival and delayed graft function in first-time and repeat kidney transplants.

The aim of this meta-analysisis to compare graft survival and delayed graft function (DGF) outcomes in first-time KT, repeat KT (regrafts) and subsequent KT.

本次荟萃分析的目的是比较初次肾脏移植、重复肾脏移植（再次移植）和随后肾脏移植的移植物存活率和延迟性移植肾功能不全（DGF）的结果。

Methods

Relevant studies were identified through comprehensive searches in PubMed, Web of Science, Cochrane Library, MEDLINE (Ovid) and Scopus until 8 October 2024.

通过在PubMed、Web of Science、Cochrane图书馆、MEDLINE（Ovid）和Scopus中进行综合搜索，直至2024年10月8日，确定了相关研究。

Primary outcomes include graft survival and DGF, compared with repeat and subsequent KT.

主要结果包括移植物存活率和延迟性肾功能恢复（DGF），与重复和随后的肾脏移植（KT）进行比较。

Results

The meta-analysisincluded a total of 16 studies.

该荟萃分析共纳入了16项研究。

Analysis on long-term graft survival revealed that patients who underwent a first KT had significantly better graft survival compared with those who received a second transplant [86.7% versus 77.6%; odds ratio (OR) 1.40, 95% confidence interval(CI) 1.14-1.71, P = .001].

对长期移植物存活率的分析显示，接受首次肾移植的患者与接受二次移植的患者相比，移植物存活率显著更高[86.7%对比77.6%; 比值比(OR) 1.40, 95%置信区间(CI) 1.14-1.71, P = .001]。

At 5 years post-transplant, first KT recipients continued to demonstrate superior graft survival (OR 1.41, 95% CI 1.13-1.77, P = .003), although this difference diminished by 10 years, with no significant disparity observed (OR 1.26, 95% CI 0.88-1.81, P = .20).

移植后5年，首次肾移植受者继续显示出更高的移植物存活率（OR 1.41，95% CI 1.13-1.77，P = .003），尽管这一差异在10年时减少，未观察到显著差异（OR 1.26，95% CI 0.88-1.81，P = .20）。

Graft survival at 5 years was also significantly higher in second KT recipients compared with those undergoing a third transplant (OR 2.66, 95% CI 1.86-3.80, P < .00001).

移植后5年，第二次肾移植受者的移植物存活率也显著高于进行第三次移植的受者（OR 2.66，95% CI 1.86-3.80，P < .00001）。

Patient survival outcomes were largely comparable between first and second KT groups, with no statistically significant differences in overall survival(OR 1.25, 95% CI 0.87-1.81, P = .23).

患者生存结果在首次和第二次肾脏移植（KT）组之间大致相当，总生存率没有统计学上的显著差异（OR 1.25, 95% 置信区间 0.87-1.81, P = .23）。

At specific time points, the 5-year survival rate showed a borderline non-significant trend favoring first KT recipients (OR 1.63, 95% CI 0.97-2.73, P = .06), while the 10-year survival rate showed no difference (OR 0.94, 95% CI 0.67-1.32, P = .71).

在特定时间点，5年生存率显示出倾向于首次KT接受者的边缘非显著趋势（OR 1.63, 95% 置信区间 0.97-2.73, P = .06），而10年生存率没有差异（OR 0.94, 95% 置信区间 0.67-1.32, P = .71）。

Survival rates between second and subsequent retransplants (e.g. third or fourth KT) showed no significant variation, including at 5 years (P = .37 and P = .90, respectively).

第二次和随后的再次移植（例如第三次或第四次肾移植）之间的存活率没有显著差异，包括5年存活率（P = .37和P = .90，分别）。

DGF rates did not differ significantly between first and second KT recipients (P = .11).

首次和第二次肾移植受者的延迟性肾功能恢复（DGF）率没有显著差异（P = .11）。

Conclusions

These findings underscore the superior graft survival associated with first and second KT compared with subsequent retransplants, particularly in the early post-transplant period, while highlighting the lack of significant differences in overall patient survival across groups; however, variability in outcomes due to study heterogeneity and patient-specific factors warrants cautious interpretation and tailored clinical approaches.

这些发现强调了与首次和第二次肾移植（KT）相比，随后的再次移植在移植后早期与更好的移植物存活率相关，尤其是在移植后早期，同时指出了各组之间患者总生存率没有显著差异；然而，由于研究异质性和患者特定因素导致的结果变异性，需要谨慎解释并采取定制化的临床方法。