Ten-Year Follow-up of a Reused Kidney Graft for Transplant Using Sirolimus for Maintenance Immunosuppression

• Published in: Transplantation proceedings 2015-12, Vol.47 (10), p.3027-3030
• Main Authors: Lugo-Baruqui, J, Burke, G.W, Guerra, G, Ruiz, P, Ciancio, G
• Format: Article
• Language: English
• Subjects: Adult; Follow-Up Studies; Forecasting; Graft Rejection - drug therapy; Graft Rejection - immunology; Graft Survival; Humans; Immunosuppression - methods; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - methods; Male; Middle Aged; Reoperation; Sirolimus - therapeutic use; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2015.10.031

Abstract Reused kidney grafts have been transplanted with successful outcomes, though not widely performed in the Unites States. We present the case of a reused kidney graft with 10-year follow-up. The first donation was from a patient who died from a cerebrovascular accident and whose organs were used for a simultaneous pancreas and kidney transplant. After 5 years, the patient died and kidney was considered for donation and reuse. The patient had a virtual crossmatch with the first donor and a complement-dependent and flow-dependent crossmatch with the second donor. Long-term immune suppression was kept with a calcineurin-inhibitor–free regimen with sirolimus to prevent further damage from the first recipient. Control kidney biopsy showed steady progression of previous CNI toxicity without further damage. We describe the immunological basis of reused graft, the technical aspects of procurement and transplantation, as well as the use of Mammalian target of rapamycin for maintenance immunosuppression with good long-term results. Reused kidney grafts can be a good source of kidney grafts when adequate selection between donor and recipients is made and immunosuppression protocol is tailored to the preexisting damage to the original graft.