Single-center experience with third and fourth kidney transplants

Abstract

Summary Kidney retransplantation is often associated with a higher immunological risk than is primary renal transplantation. Faced with increasing organ shortage and growing waiting lists, results of kidney retransplantation are of particular interest. Fifty‐six third and fourth kidney transplants were analyzed retrospectively. Parameters included patient and donor demographics, operative details, incidence of surgical, immunological and infectious complications and patient and graft survival. Patients receiving third kidney grafts had 1‐ and 5‐year patient/graft survival rates of 97.4%/72.9% and 88.9%/53.6%, respectively. Episodes of acute rejection and delayed graft function were observed in 44% and 49% of these patients. Fourth kidney transplantation was associated with 1‐ and 2‐year patient/graft survival rates of 84.8%/68.5% and 63.6%/47%, respectively. Acute rejection and delayed graft function occurred in 33% and in 60% of cases. Acceptable patient and graft survival may be achieved after third and fourth kidney transplantation. Graft losses in this sensitized population are mainly because of rejection. Profound immunosuppression may lead to major infectious problems.

Outcome of Patients after Third and Fourth Kidney Transplantation

“…Technical difficulties may arise when positioning the allograft into the previously manipulated fossa iliac by prior transplant. It is observed that there is often a restricted access to the iliac vessels because of previous transplantations [7,16]. Our results confirm the surgical challenge of third and fourth transplantations with an overall complication rate of 46.2 and 66.7% with 3 major complications, classified by Clavien-Dindo scale.…”

Kidney Retransplantation in the Ipsilateral Iliac Fossa: A Surgical Challenge

“…Surgical complications occurred in 21 patients including four patients with a wound dehiscence, four hydronephrosis, four hematomas, two lymfoceles, two perforations of the bowel, one rupture of the anastomosis, and one torsion of the kidney graft. Two grafts were lost due to the bowel perforation (14). LaMattina and coworkers have analyzed long-term graft survival for renal retranplants in prior simultaneous pancreas-kidney recipients.…”

Graft and Patient Survival Outcomes of a Third Kidney Transplant

“…Consequently renal allograft failure has become one of the most common causes of ESRD and an increasing number of patients are being relisted and re-transplanted after an initial failed kidney transplant (2-5). Repeat transplantation confers a survival advantage to patients over dialysis and has graft survival approaching primary transplants in selected candidates (6-10). However the modest decrease in graft and patient survival in second transplant recipients has generated unease within the transplant community about overall utility and resource allocation in repeat renal transplantation (2, 6, 11-16).…”

“…Repeat transplantation confers a survival advantage to patients over dialysis and has graft survival approaching primary transplants in selected candidates (6-10). However the modest decrease in graft and patient survival in second transplant recipients has generated unease within the transplant community about overall utility and resource allocation in repeat renal transplantation (2, 6, 11-16). Given the current shortage of renal allografts and the fact that kidney transplant failure is becoming one of the primary indications for kidney transplantation generally, these concerns will likely only increase with time as more repeat transplant recipients are listed.…”