A Third Renal Transplantation: Is It Relevant and Is It Worth It?

• Published in: Transplantation proceedings 2005-12, Vol.37 (10), p.4199-4202
• Main Authors: Reboux, A.H., Kamar, N., Fort, M., Rischmann, P., Malavaud, B., Cointault, O., Abbal, M., Durand, D., Rostaing, L.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cadaver; Female; France; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival; Histocompatibility Testing; HLA Antigens; Humans; Immunosuppressive Agents - therapeutic use; Kidney Diseases - classification; Kidney Diseases - surgery; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Kidney Transplantation - statistics & numerical data; Male; Medical sciences; Nephrectomy; Postoperative Complications - classification; Postoperative Complications - epidemiology; Renal Dialysis; Reoperation - economics; Reoperation - statistics & numerical data; Reproducibility of Results; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Analysis; Tissue Donors; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.11.043

The aim of this retrospective study was to determine the outcome of third cadaveric renal transplantations performed between 1989 and 2004 among a cohort of 35 patients whose immunosuppression included induction therapy and calcineurin inhibitors. Most patients were highly sensitized with 1 (0–4) HLA (classes I + II) incompatibility between donor and recipient. The median follow-up time was 57 months (range, 1–190). Fourteen patients experienced delayed graft function that required posttransplantation hemodialysis. The current patient and graft survival rates were 91.4% and 82.8%, respectively. At last follow-up, 6 grafts had been lost: 1 due to primary nonfunction; 1 due to an urinary leak (day 45); 2 deaths with functioning grafts; and 2 chronic allograft nephropathies (CAN) at 85 and 60 months posttransplantation, respectively. Among the 10 patients who experienced acute rejection episodes, half were steroid-sensitive, whereas the others required OKT3 therapy. Overall, when excluding the 2 patients who presented with early loss of their grafts, 13 of 33 patients (39.4%) developed CAN, which led to the graft loss in only 2 cases. The mean creatinine clearance was 57 ± 23 mL/min at year 5. Of the 35 recipients, 12 (34.3%) developed graft/perigraft complications, among whom 10 (83.3%) required treatment. The most frequent complication was lymphocele (M = 4; 11.4%) or infections that led to rehospitalization (n = 17). Results from third transplantations were encouraging. Thus, despite the organ shortage, a third graft was worth it!