Background. This is established today that second renal transplant recipients (STR) and first renal transplant recipients (FTR) have close outcomes. However, to our knowledge, the comparison of risk factors associated with graft failure between STR and FTR has never been performed.

Methods. We propose a multiplicative-regression model for relative survival (MRS model) to study the factors associated with the time to graft failure (return-to-dialysis or patient death) of STR compared to a matched population of FTR. We performed an observational prospective study based on 641 STR from the multicentric French DIVAT database transplanted between 1996 and 2010. The expected graft failure hazard was estimated using a semi-parametric proportional hazard model based on 2462 FTR performed over the same period.

Results. The graft failure hazard associated with the recipient age (≥ 55 years versus < 55 years) was 1.6-fold higher for STR compared to FTR (P = 0.0387). Conversely, graft failure hazards associated with the donor age (≥ 55 years versus < 55 years) and the donor type (deceased versus living donor) were respectively 1.7-fold lower (P = 0.0294) and 3-fold lower (P = 0.0332) for STR compared to FTR.

Conclusions. We developed for the first time in renal transplantation a MRS model to study the effect of factors associated with graft failure for STR and based on an estimated expected hazard from FTR. This innovative use of the MRS model offers original clinical results useful for clinicians.

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