The impact of allograft nephrectomy on percent panel reactive antibody and clinical outcome

Nephrectomy After Transplant Failure: Current Practice and Outcomes

“…Others have reported an increase in PRA after transplant nephrectomy (7,13). Our results are most consistent with those of Khakar and colleagues who found an overall increase in PRA level 6 months post nephrectomy and also observed that the change in PRA post nephrectomy was related to the pre nephrectomy PRA level (6). The effect of transplant nephrectomy on PRA levels may vary over time.…”

“…1 Percentages are shown unless otherwise indicated. 2,3,4,5,6,7 Data were available for 73%, 79%, 59%, 82%, 82%, 93%, of patients, respectively. 8 Defined by the need for dialysis prior to discharge from hospital after transplantation.…”

“…The impact of the retained failed allograft on the health of transplant failure patients is unknown, and warrants examination because the failed graft could be removed if shown to be harmful. Similarly, although a number of studies have examined the effect of transplant nephrectomy on sensitization, (6,7,13,14) and on repeat transplant survival, (1,3,7,13) there is no consensus regarding these issues. Given that the number of patients returning to dialysis after transplant failure is increasing (16,17,(20)(21)(22), we performed this study to describe the current practice and consequences of transplant nephrectomy in the United States.…”

Kidney Transplant Failure

“…Moreover, the transplanted kidney itself may be an ongoing source of systemic inflammation and hypoalbuminemia even in the absence of overt clinical evidence of rejection (10). Taken together, the role of transplant-specific modifiable practices after graft loss, including the method and rapidity of immunosuppression tapering and/or the indications for and timing of transplant nephrectomy in improving outcomes after transplant failure, remain unclear (11)(12)(13)(14).…”

Sequestration and Suppression of Anti-HLA Antibodies by a Failed Kidney Allograft

“…Transplant nephrectomy may also limit long-term cardiovascular risk (1). Despite these potential benefits, transplant nephrectomy can be complicated by morbidities surrounding surgery, and several retrospective reports suggest that nephrectomy is associated with an increase in circulating anti-HLA antibodies (1)(2)(3)(4)(5)(6). The enduring implications of the latter are significant because anti-HLA antibodies confer both an increase wait time for retransplantation and elevated risk for subsequent graft failure (7,8).…”