Selective Retransplant After Graft Loss to Nonadherence: Success with a Second Chance

Abstract

Nonadherence (NA) is a difficult posttransplant problem that can lead to graft loss. A retransplant for these recipients is controversial because of a fear of recurrent NA. We reviewed our center’s database and identified 119 recipients who lost their graft to overt NA; of this group, 38 (32%) underwent a retransplant after a thorough reevaluation. We compared this NA retransplant group to a control group of 2nd transplant recipients who did not lose their 1st graft to overt NA (n=728). After 8 years of follow-up, we found no differences between the 2 groups in actuarial graft or patient survival rates, renal function, or the incidence of biopsy-proven chronic rejection. However, 3 of 38 NA recipients vs. 9 of 728 2nd transplant recipients lost their retransplant to NA (p=0.03). We conclude that prior graft loss to NA is associated with increased graft loss to NA after retransplant; still, the majority of NA retransplant recipients did well – their overall long-term outcomes were similar to those of the 2nd transplant group. With careful patient selection and aggressive intervention, prior NA should not be an absolute contraindication to a retransplant.

Lower Variability of Tacrolimus Trough Concentration After Conversion From Prograf to Advagraf in Stable Kidney Transplant Recipients

“…Monitoring the C 0 of tacrolimus is essential to optimize the outcome of renal allograft survival in kidney transplant recipients with tacrolimus-based regimen. Nonadherence is a difficult posttransplant problem that can lead to graft loss (1). A switch to once-daily medication may improve adherence.…”

Should we retransplant a patient who is non‐adherent? A literature review and critical reflection

“… Results of the screening process of candidates for retransplantation because of NA in the study of Dunn et al. (18). (figure on page 1340 copied with the permission of editor).…”

“…With only one paper having been published, the evidence base to judge whether patients losing their graft because of NA to the immunosuppressive regimen should be retransplanted is hard to answer. The cohort study of the University of Minnesota (18) generated the following key messages: (i) recurrence of NA is prevalent despite having implemented a screening protocol and (ii) clinical outcomes are poorer in those being retransplanted for overt NA compared to patients undergoing retransplantation for other reasons.…”

“…The study of Dunn et al. (18) showed that outcomes after retransplantation were also poorer in those transplanted for prior NA. In addition, more than half of the patients show recurrent NA, even after establishing a pattern of adherence long enough to meet the requirements of their screening protocol.…”

Trasplante renal con donante vivo en Colombia

“…A nivel de la literatura médica son varios los trabajos de series o revisiones que demuestran las bondades de este de este tipo de trasplante y de las complicaciones mínimas del donante en cuanto, HTA, ERC, DM, sobrevida, con un RR similar al de la población engeneral 1,17 Podemos seguir enumerando las experiencias de muchos grupos con respecto a esta modalidad de tratamiento, pero nuestro punto final es determinar el riesgo sometido al DV:en el perioperatorio (atelectasia/ neumotórax, neumonía, ITU, complicaciones de la herida Qca, TVP/TEP), todo ello depende, en gran parte, de la modalidad quirúrgica empleada en la nefrectomía, la tradicional o laparoscópica y de la experiencia del Centro 5,20 ; la mortalidad en < de 90 días es mínima 3.1/10.000,tal como lo demuestra la serie de 80.347 donantes, seguida durante 6 años 20 ; pero a nivel tardío se viene argumentando en forma creciente que esta práctica médica no está exenta de problemas, que existe un ligero RR, de desarrollar DM o enfermedad cardiovascular al comparar el donante con la población general; que el grado de adaptación psicosocial depende en un alto grado del estrato previo del donante [21][22][23] .…”