Living-donor kidney retransplantation: risk factors and outcome

BJU Int. 2004 Aug;94(3):369-73. doi: 10.1111/j.1464-410X.2004.04934.x.

Abstract

Objective: To review the results of kidney retransplantation at our centre.

Patients and methods: Between March 1976 and January 2002, 1406 kidneys were transplanted; among these, 54 patients received a second graft (39 men, mean age 32.1 years, sd 8.6). The donors were 48 relatives (mean age 35.4 years, sd 10.1).

Results: The mean (sd, range) duration of the first graft was 49.1 (45.9, 1-192) months and the main cause of these grafts failing was immunological. The mean duration of graft failure was 17.3 (10.5, 5-62) months. The rate of histocompatibility leukocyte antigen (HLA)-A, -B >3 was 16.7% and of haplotype DR matching was 11%. The immunosuppression regimen was mainly based on cyclosporin (75%). There were 33 episodes of acute rejection in 23 patients. The major complications were hypertension (70%), infections (30%) and hepatitis (11%). The overall graft and patient survival was good; 15 grafts (27%) were lost during the follow-up of 1-17 years. Ten patients died, five with a functioning graft. Multivariate analysis showed that donor relationship, primary immunosuppression, duration of first graft and serum creatinine level at 1 year were predictors of graft survival.

Conclusion: Renal retransplantation is the treatment of choice in patients who have lost their graft. The use of related living-donors and potent immunosuppression could help to improve the outcome.

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / methods*
  • Living Donors*
  • Male
  • Postoperative Complications / etiology
  • Reoperation
  • Risk Factors
  • Treatment Outcome

Substances

  • Immunosuppressive Agents