BACKGROUND: Third kidney retransplants have technical and immunologic hurdles that may preclude success, which is of particular importance in the contemporary context of discrepancy between organ supply and demand. METHODS: The outcomes of third renal transplant recipients (TRTR) were compared with those receiving a first transplant from paired donor kidneys to assess transplant success and complication rates. The Ontario-based Trillium Gift of Life Network database was used to identify deceased donors (n=28) who donated one kidney to a TRTR and the mate kidney to a primary renal transplant recipient (PRTR) from June 1977 to August 2006. RESULTS: As anticipated, TRTR were sensitized versus PRTR based on % panel reactive antibodies (24%+/-34% vs. 7%+/-14%, P=0.03). Delayed graft function (46% vs. 22%, P=0.05) and biopsy-proven rejection episodes (50% vs. 29%, P=0.01) occurred more frequently with TRTR despite greater frequency of induction therapy (74% vs. 35%, P=0.004). However, 1- and 5-year patient survival were similar at 93%, 83% and 96%, 87% for TRTR and PRTR, respectively. Accordingly, 1- and 5-year allograft survival censored for mortality, were comparable at 78%, 66% and 78%, 75%. Renal function was similar in both groups. Bacterial infections (43% vs. 18%, P=0.001) and wound problems (28% vs. 11%, P=0.09) were the only postoperative complications to occur more frequently in the TRTR. CONCLUSION: We conclude that third renal transplantation should not be discouraged based on functional outcomes alone.
BACKGROUND: Third kidney retransplants have technical and immunologic hurdles that may preclude success, which is of particular importance in the contemporary context of discrepancy between organ supply and demand. METHODS: The outcomes of third renal transplant recipients (TRTR) were compared with those receiving a first transplant from paired donor kidneys to assess transplant success and complication rates. The Ontario-based Trillium Gift of Life Network database was used to identify deceased donors (n=28) who donated one kidney to a TRTR and the mate kidney to a primary renal transplant recipient (PRTR) from June 1977 to August 2006. RESULTS: As anticipated, TRTR were sensitized versus PRTR based on % panel reactive antibodies (24%+/-34% vs. 7%+/-14%, P=0.03). Delayed graft function (46% vs. 22%, P=0.05) and biopsy-proven rejection episodes (50% vs. 29%, P=0.01) occurred more frequently with TRTR despite greater frequency of induction therapy (74% vs. 35%, P=0.004). However, 1- and 5-year patient survival were similar at 93%, 83% and 96%, 87% for TRTR and PRTR, respectively. Accordingly, 1- and 5-year allograft survival censored for mortality, were comparable at 78%, 66% and 78%, 75%. Renal function was similar in both groups. Bacterial infections (43% vs. 18%, P=0.001) and wound problems (28% vs. 11%, P=0.09) were the only postoperative complications to occur more frequently in the TRTR. CONCLUSION: We conclude that third renal transplantation should not be discouraged based on functional outcomes alone.
Authors: Ernesto P Molmenti; Asha Alex; Lisa Rosen; Mohini Alexander; Jeffrey Nicastro; Jingyan Yang; Eric Siskind; Leesha Alex; Emil Sameyah; Madhu Bhaskaran; Nicole Ali; Amit Basu; Mala Sachdeva; Stergiani Agorastos; Prejith Rajendran; Prathik Krishnan; Poornima Ramadas; Leo Amodu; Joaquin Cagliani; Sameer Rehman; Adam Kressel; Christine B Sethna; Georgios C Sotiropoulos; Arnold Radtke; George Sgourakis; Richard Schwarz; Steven Fishbane; Alessandro Bellucci; Gene Coppa; Horacio Rilo; Christine L Molmenti Journal: Int J Angiol Date: 2015-09-15
Authors: Lampros Kousoulas; Florian W R Vondran; Paulina Syryca; Juergen Klempnauer; Harald Schrem; Frank Lehner Journal: J Transplant Date: 2015-02-01
Authors: Gábor Telkes; László Piros; József Szabó; Gergely Huszty; Katalin Eitler; László Kóbori Journal: Langenbecks Arch Surg Date: 2021-01-17 Impact factor: 3.445
Authors: Shaifali Sandal; JiYoon B Ahn; Dorry L Segev; Marcelo Cantarovich; Mara A McAdams-DeMarco Journal: Am J Transplant Date: 2021-08-23 Impact factor: 8.086