Long-Term Outcome on Kidney Retransplantation: A Review of 100 Cases From a Single Center

Barocci, S; Valente, Umberto; Fontana, I.; Tagliamacco, Augusto; Santori, Gregorio; Mossa, Michelangela; Ferrari, Emanuela; Trovatello, G.; Centore, C.; Lorenzi, Sandra; Rolla, Davide; Nocera, Arcangelo

doi:10.1016/j.transproceed.2009.03.083

Cited by 22 publications

(11 citation statements)

References 10 publications

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“…This is consistent with previous reports on outcomes for second kidney grafts (1-year graft survival 85-89%) (26,27). Our findings, therefore, suggest that re-transplantation after EGL should be considered for selected cases.…”

Section: Discussionsupporting

confidence: 93%

Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences

Hamed

Chen²,

Pasea

et al. 2015

American Journal of Transplantation

112

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Early graft loss (EGL) after kidney transplantation is a catastrophic outcome that is assumed to be more likely after the use of kidneys from suboptimal donors. We therefore examined its incidence, risk factors and consequences in our center in relation to different donor types. Of 801 recipients who received a kidney-only transplant from deceased donors, 50 (6.2%) suffered EGL within 30 days of transplantation. Significant risks factors for EGL were donation after circulatory death (DCD) (odds ratio [OR] 2.88; p ¼ 0.006), expanded criteria donor (ECD) transplantation (OR 4.22; p ¼ 0.010), donor age (OR 1.03; p ¼ 0.044) and recipient past history of thrombosis (OR 4.91; p ¼ 0.001). Recipients with EGL had 12.28 times increased risk of death within the first year, but long-term survival was worse for patients remaining on the waiting list. In comparison with patients on the waiting list but not transplanted, and with all patients on the waiting list, the risk of death after EGL decreased to baseline 4 and 23 months after transplantation, respectively. Our findings suggest that DCD and ECD transplantation are significant risk factors for EGL, which is a major risk factor for recipient death. However, long-term mortality is even greater for those remaining on the waiting list.

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Section: Discussionsupporting

confidence: 93%

Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences

Hamed

Chen²,

Pasea

et al. 2015

American Journal of Transplantation

112

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“…Universally reported KRT graft survival has been lower than primary transplant, but re-transplantation is still advantageous over maintenance hemodialysis or peritoneal dialysis in terms of improved patient survival, better quality of life, and cost effectiveness (5)(6)(7)9,10,(31)(32)(33)(34)(35). This study showed that the short and intermediate graft survival rates of repeat kidney transplantation were not significantly different between the two groups.…”

Section: Discussionmentioning

confidence: 60%

“…In 2008 in the United States, 18% of wait listed and 13% of those receiving a kidney transplant had been transplanted previously (4). The survival of KRT is only slightly lower than that of the first transplant (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Early Steroid Withdrawal in Repeat Kidney Transplantation

Mujtaba¹,

Taber²,

Goggins³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Kidney re-transplantation (KRT) candidates are considered at high risk for graft failure. Most of these patients are kept on a chronic steroid maintenance (CSM) regimen. The safety of early steroid withdrawal (ESW) remains unanswered in KRT.Design, setting, participants, & measurements This study was aimed at comparing the outcomes of ESW and CSM in KRT. Retrospective analysis of 113 KRT patients (ESW, n ϭ 59; CSM, n ϭ 54) was performed. All patients received rabbit anti-thymocyte globulin/steroid induction and were maintained on mycophenolate/tacrolimus (Ϯsteroids).Results One-and 5-year patient survival for the ESW and the CSM group were not significantly different (98 versus 96% and 91 versus 88%, respectively; P ϭ 0.991). No significant difference was seen in the graft survival for both groups at 1 and 5 years (98 versus 93% and 80 versus 74%, respectively; P ϭ 0.779). Mean 1-and 5-year estimated GFR was not statistically different between the groups (P ϭ 0.773 and 0.790, respectively). The incidence of acute rejection at 1 year was 17 and 22% in ESW and CSM patients, respectively (P ϭ 0.635). Compared with the ESW group, patients in the CSM group were more likely to be hyperlipidemic (P ϭ 0.044), osteoporotic (P ϭ 0.010), post-transplant diabetics (P ϭ 0.051) and required more medications to control BP (P ϭ 0.004).Conclusions ESW seems to be a reasonable approach in KRT recipients because the short and intermediate patient survival, graft survival, and graft function is comparable to CSM immunosuppression.

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“…Acute vascular rejection and chronic transplant dysfunction remain the most relevant risk factors for long-term graft survival (1,2). Data from the Organ Procurement and Transplantation Network show graft survival rates for primary kidney transplants of 92%, 82%, and 72% after 1, 3, and 5 years, respectively (3).…”

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confidence: 99%

AMP-Activated Protein Kinase as a Target for Preconditioning in Transplantation Medicine

et al. 2010

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Graft quality before transplantation is a major factor influencing chronic rejection. Organ preservation and ischemia/reperfusion play an important role in the induction of organ injury. Although both suppression of metabolism by hypothermic preservation and preconditioning before ischemia limit injury, understanding the biochemical signaling pathways will allow us to optimize graft preservation further. Adenosine monophosphate-activated protein kinase (AMPK) is an important enzyme sensing cellular energy balance and regulating downstream signaling pathways, signaling toward an energy-conserving state. In this review, we summarize available literature regarding the protective signaling pathways activated by (hypothermic) ischemia and preconditioning and how they can be activated pharmacologically. Optimizing the graft quality before transplantation improves long-term graft survival. The major factor influencing organ quality is organ preservation, cold storage, currently, being a common practice. Loss of cellular homeostasis, inflammation, and endothelial dysfunction are the major factors inducing injury after cold storage. Adenosine triphosphate depletion and anaerobic metabolism during the cold ischemic period lead to mitochondrial dysfunction, disturbed osmoregulation, and cell death inducing inflammation. Ischemic preconditioning consists of brief periods of ischemia preceding preservation and protects organs against injury because of subsequent ischemia/reperfusion, in which endothelial nitric oxide synthase, nuclear factor-kB, and adenosine play a major role. After conversion of adenosine to AMP, AMPK can be activated, a central kinase involved in sensing cellular [AMP]:[adenosine triphosphate] levels and signaling toward an energy-conserving state. Pharmacologic activation of AMPK demonstrated its ability to activate endothelial nitric oxide synthase and inhibit nuclear factor-kB, thereby limiting endothelial dysfunction and inflammation. Further, studies in knock-out mice lacking ENTDP1 and NT5E (enzymes catalyzing formation and degradation of AMP, respectively) demonstrated a clear protective role for AMP in ischemia/reperfusion. AMPK activation before or during organ preservation might be a promising pharmacologic approach to limit organ injury and maintain graft quality before transplantation.

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Long-Term Outcome on Kidney Retransplantation: A Review of 100 Cases From a Single Center

Cited by 22 publications

References 10 publications

Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences

Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences

Early Steroid Withdrawal in Repeat Kidney Transplantation

AMP-Activated Protein Kinase as a Target for Preconditioning in Transplantation Medicine

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