Graft Survival in Patients Who Received Second Allograft, Comparing Those With or Without Previous Failed Allograft Nephrectomy

Sánchez, Á.; Carrasco‐Valiente, Julia; Arenas-Bonilla, A.J.; Campos-Hernández, J.P.; Blanca, Ana; Ruiz-García, J.; Valero-Rosa, J.; Gómez, Enrique Gómez; Salamanca-Bustos, J.J.; Navarro-Cabello, D.; Requena-Tapia, M.J.

doi:10.1016/j.transproceed.2016.09.016

Cited by 11 publications

(16 citation statements)

References 10 publications

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“…It also increases the likelihood of developing antibodies to human leukocyte antigens (HLA) . The effect of the formation of these antibodies on subsequent kidney transplantations is unclear, as several studies show conflicting results of retransplantation .…”

Section: Introductionmentioning

confidence: 99%

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

et al. 2017

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Graft nephrectomy is recommended in case of early graft failure. When the graft fails more than 3-6 months after transplantation, it is current practice to follow a wait-and-see policy. A common indication for graft removal is the graft intolerance syndrome. We aimed to create a risk prediction model for the occurrence of graft intolerance resulting in graft nephrectomy. We collected data of kidney transplantations performed in our center between 1980 and 2010 that failed at least 6 months after transplantation. We evaluated the association between baseline characteristics and the occurrence of graft nephrectomy because of graft intolerance using a competing risk regression model. Prognostic factors were included in a multivariate prediction model. In- and exclusion criteria were met in 288 cases. In 48 patients, the graft was removed because of graft intolerance. Donor age, the number of rejections, and shorter graft survival were predictive factors for graft nephrectomy because of the graft intolerance syndrome. These factors were included in a prediction rule. Using donor age, graft survival, and the number of rejections, clinicians can predict the need for graft nephrectomy with a reasonable accuracy.

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Section: Introductionmentioning

confidence: 99%

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

et al. 2017

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“…Patients who return to dialysis after graft failure have a high mortality [4,5]. Retransplantation is an important option to consider, since there is a mortality reduction around 45% in these patients [9][10][11][12]. HLA allosensitization is a determining factor that prolongs the waiting time for transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Due to this, the possibility of performing a retransplant is crucial in these patients, and this option significantly reduces mortality in approximately 45% [9,10]. Graft survival after retransplantation is lower than after the first graft, but remains sufficiently high [11,12].…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression with Calcineurin Inhibitor after Renal Transplant Failure Inhibits Allosensitization

et al. 2020

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Immunosuppression withdrawal after graft failure seems to favor sensitization. A high percentage of calculated panel-reactive antibody (cPRA) and the development of de novo donor specific antibodies (dnDSA) indicate human leukocyte antigen (HLA) sensitization and may hinder the option of retransplantation. There are no established protocols on the immunosuppressive treatment that should be maintained after transplant failure. A retrospective analysis including 77 patients who lost their first renal graft between 1 January 2006–31 December 2015 was performed. Two sera were selected per patient, one immediately prior to graft loss and another one after graft failure. cPRA was calculated by Single Antigen in all patients. It was possible to analyze the development of dnDSA in 73 patients. By multivariate logistic regression analysis, the absence of calcineurin inhibitor (CNI) at 6 months after graft failure was related to cPRA > 75% (OR 4.8, CI 95% 1.5–15.0, p = 0.006). The absence of calcineurin inhibitor (CNI) at 6 months after graft loss was significantly associated with dnDSA development (OR 23.2, CI 95% 5.3–100.6, p < 0.001). Our results suggest that the absence of CNI at the sixth month after graft loss is a risk factor for sensitization. Therefore, maintenance of an immunosuppressive regimen based on CNI after transplant failure should be considered when a new transplant is planned, since it seems to prevent HLA allosensitization.

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“…When a kidney transplant fails, a decision must be made whether to remove the graft or to leave it in situ . In literature, the rate of allograft nephrectomy varies widely between 9% and 75% reflecting the lack of a standard policy [1–10]. In case of early graft failure (within 3–6 months after transplantation) or primary nonfunction, the graft is usually removed to avoid systemic and local effects of acute rejection and to allow complete withdrawal of immunosuppressive medication.…”

Section: Introductionmentioning

confidence: 99%

“…Other potential indications are infectious complications, severe hypertension, refractory nephrotic syndrome, proven or suspected graft malignancy, and the need to create space for retransplantation. From previous studies, it can be concluded that most allograft nephrectomies are performed within 12 months of graft failure [1–10].…”

Section: Introductionmentioning

confidence: 99%

Histopathological examination of removed kidney allografts: Is it useful? A retrospective cohort study

2020

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The incidence and relevance of histological findings in removed allografts is unknown. In this study, we investigated the outcome of routine histopathological examination of removed allografts. We performed a retrospective cohort study in patients with kidney graft failure ≥3 months after transplantation. In this cohort, 244 allograft nephrectomies were performed. We routinely sent removed grafts for histopathological examination. In 197 cases, a pathology report was available for analysis. In 21 of the 197 grafts, gross necrosis precluded adequate interpretation. Signs of rejection were reported in 163 of the remaining 176 allografts. Recurrences of the original disease were found in 13 cases. These were all known from prior biopsies. Relevant secondary findings were present in eight cases: renal cell carcinoma (n = 2), urothelial cell carcinoma, candida pyelonephritis (n = 2), post-transplant lymphoproliferative disease, polyomavirus inclusions, and membranous nephropathy. All conditions were diagnosed before graft nephrectomy, except for one case of papillary renal cell carcinoma of 0.8 cm. As expected, signs of acute and/or chronic rejection are the main histopathological finding in grafts that are removed after late graft failure. Unexpected secondary findings are very rare. Therefore, it is justifiable to restrict histopathological examination of removed kidney allografts to specific cases.

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Graft Survival in Patients Who Received Second Allograft, Comparing Those With or Without Previous Failed Allograft Nephrectomy

Cited by 11 publications

References 10 publications

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

Immunosuppression with Calcineurin Inhibitor after Renal Transplant Failure Inhibits Allosensitization

Histopathological examination of removed kidney allografts: Is it useful? A retrospective cohort study

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