Immunologic and non-immunologic complications of a third kidney transplantation

Abstract

Background/Aims:Patients who undergo repeat kidney transplantations (KTs) are considered at high risk for experiencing immunologic and non-immunologic complications. In this study, we investigated the clinical outcomes, including medical and surgical complications, of patients who underwent a third KT at our center.Methods:Between March 1969 and December 2012, a total of 2,110 KTs were performed at the Seoul St. Mary’s Hospital. Of them, we examined 11 patients who underwent a third KT, and investigated the allograft outcomes and complication rates.Results:The mean follow-up duration after KT was 72.4 ± 78.3 months. The mean age at KT was 38.2 ± 8.0 years, and seven patients (63.6%) were males. Nine patients (81.8%) underwent living-donor KT. A cross-match test yielded positive results in four of the nine patients, and all underwent pretransplant desensitization therapy. After KT, three patients (27.2%) showed delayed graft function. Acute rejection developed in four patients (36.4%), and surgical complications that required surgical correction occurred in three patients. Allograft failure developed due to acute rejection (n = 3) or chronic rejection (n = 1) in four patients. Allograft survival rates at 1, 5, and 10 years were 81.8%, 42.9%, and 42.9%, respectively; however, the allograft survival rate at 5 years was > 80% in patients who underwent KT only after results of the panel reactive antibody test became available.Conclusions:Thus, a third KT procedure may be acceptable, although aggressive pretransplant immune monitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications.

Outcome of Patients after Third and Fourth Kidney Transplantation

“…Regarding the graft survival, our study presents a survival of 100% after 1 year and 74.1% after 5 years, respectively. These patient and graft survival rates of third graft recipients correlate with the results presented by almost all the recent studies [2,3,4,5,6,7,8,9]. …”

“…In the latest study by Kim et al [7], allograft survival rates for third graft recipients at 1 and 5 years of 81.8 and 42.9% were observed, respectively. Izquierdo et al [12] reported 92.7 and 90.6% patients and 88 and 76.4% graft survivals of third transplantation at 1 and 5 years, respectively.…”

“…In large series of studies, it was observed that a big number of transplant recipients faced graft loss and had to return to dialysis [7,8,9,10,11]. A high risk of graft loss has been associated with re-transplantation.…”

“…Moreover, it was shown that second graft recipients have a better outcome compared to patients who return to dialysis after allograft failure [7]. …”

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“…In conclusion, a third kidney transplant procedure may be acceptable, although aggressive pretransplant immunomonitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications. 25 Immunosuppression A 12-month single-arm pilot trial was carried out to evaluate efficacy and safety of sirolimus-tacrolimus in high-risk patients, including 28 patients who underwent retransplant versus a retrospective control group administered tacrolimus-mycophenolate mofetil (69 recipients). All patients were given basiliximab induction therapy.…”