Retransplanting a previously transplanted kidney: A safe strategy in times of organ shortage?

Abstract

Background:The shortage of organs for transplantation remains a global problem. The retransplantation of a previously transplanted kidney might be a possibility to expand the pool of donors. We provide our experience with the successful reuse of transplanted kidneys in the Eurotransplant region.Methods: A query in the Eurotransplant database was performed between January 1, 1995 and December 31, 2015, to find kidney donors who themselves had previously received a kidney graft.Results: Nine out of a total of 68,554 allocated kidneys had previously been transplanted. Four of these kidneys were transplanted once again. The mean interval between the first transplant and retransplantation was 1689±1682 days (SD; range 55-5,333 days). At the time of the first transplantation the mean serum creatinine of the donors was 1.0 mg/dl (.6-1.3 mg/dl) and at the second transplantation 1.4 mg/dl (.8-1.5 mg/dl). The mean graft survival in the first recipient was 50 months (2-110 months) and in the second recipient 111 months (40-215 months). Conclusion:Transplantation of a previously transplanted kidney may successfully be performed with well-preserved graft function and long-term graft survival, even if the first transplantation was performed a long time ago. Such organs should be considered even for younger recipients in carefully selected cases.

The Deceased Transplant Recipients: A Forgotten Source of Organ Donors

“…The small number of case reports scattered during the last three decades [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] did not catch the attention of the transplant community until analyses were published from the organ transplant agencies on both sides of the Atlantic [33][34][35]. Lowell et al, with data of the United Network for Organ Sharing and The Scientific Transplant Registry, reported findings on forty-eight recipients of previously re-used kidneys transplanted between October 1987 and June 1996 and compared them to those of 68,568 patients receiving native organs during the same period [33]. There was no difference in the incidence of graft rejection and graft survival in the two groups, with p = NS and p = 0.20, respectively.…”

“…However, the mean age of the re-used graft was only 36 years (range 23-54), similar to that of the original donor. All kidneys functioned immediately without dialysis, suggesting that the transplant procedure was well planned and the cold ischemia time was short [33]. With the use of steroids, the transplant patients developed new and accelerated cardiovascular morbidities related to increased rates of diabetes and hypertension compared to the general population [6].…”

“…The low estimated glomerular filtration rate (eGFR) of a single kidney transplant does not have the same connotation as the eGFR of a conventional donor who has two kidneys and should not be a reason to reject an organ for re-transplantation. This was demonstrated by the fact that recipients of long-term re-used kidneys were reported to have a serum creatinine level of 1.27 mg/dL compared to 1.0 mg/dL in the original donors [33]. Despite the multiple semantic discussions involved in its determination, the glomerular filtration rate still remains the gold-standard clinical parameter of renal function.…”