Second renal transplantations. Ethical issues clarified by outcome; outcome enhanced by a reliable crossmatch.
OBJECTIVE
To determine whether the appropriate use of scarce donor resources has been accomplished by renal retransplantation by reviewing the initial and long-term outcomes of second-renal transplant recipients at the Massachusetts General Hospital, Boston.


RESULTS
With a mean follow-up of nearly 5 years following transplantation, 54 (68%) of 80 second-transplant recipients had functioning allografts (allograft failure was defined by patient death or a return to dialysis). Rejection was the most common cause of failure (14 [54%] of 26 patients). The 1-, 3-, and 5-year actuarial allograft survival rates were 86%, 78%, and 69%, respectively, which were not significantly different from the survival rates of primary allografts at this center. These results support the continued approach of providing both cadaver-donor and living-donor renal allografts for recipients whose primary renal allograft has failed. The antiglobulin crossmatch may have contributed to the successful outcome by accurately determining compatibility and by averting early rejection failures.


CONCLUSIONS
Health care policy reviewers should clearly distinguish the prospects for successful second renal transplants from the outcomes of extrarenal retransplantation. Moreover, because excellent second-renal allograft survival is attainable and comparable to primary-renal allograft survival and because the costs are comparable, restricting suitable patients to subsequent lifelong dialysis becomes unethical.
Delmonico
F L
FL
Transplantation Unit, Massachusetts General Hospital, Boston.
Tolkoff-Rubin
N
N
Auchincloss
H
H
Farrell
M L
ML
Fitzpatrick
D M
DM
Saidman
S
S
Herrin
J T
JT
Cosimi
A B
AB
D000328:Adult; D000367:Age Factors; D000906:Antibodies / Q000032:analysis; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001900:Boston / Q000453:epidemiology; D002102:Cadaver; D002648:Child; D004351:Drug Resistance; D004992:Ethics, Medical; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D006650:Histocompatibility Testing / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D012086:Reoperation; D040841:Resource Allocation; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
D000906:Antibodies; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D016853:Muromonab-CD3; D013256:Steroids