[Impact of transplantectomy of the first graft on the clinical course of cadaver renal retransplantation].
OBJECTIVE
At the present time a number of prediction factors on the outcome of second cadaver renal transplants are known, in particular the influence of recipient response to the first graft. However, we do not know if retaining or removing the non-functioning organ has any repercussion on subsequent transplants. This is the object of the present study.


METHODS
A retrospective study was carried out on the clinical records of 80 patients who had undergone a second cadaver renal transplant under CyA between 1985-1995 at Hospital 12 de Octubre. Data on the characteristics and outcome of the first and second transplants were collected, plus those concerning the recipient and donor. These variables were used to construct a multivariant analysis model of graft survival. The nephrectomy of the non-functioning graft was only carried out when absolutely necessary (n = 58).


RESULTS
The multivariant analysis showed that the nephrectomy of the non functioning graft did not modify the risk of recipient sensitization or the probability of developing acute or chronic rejection of the second graft. However, it reduced the risk of losing this second graft at medium or long term significantly (p = 0.009).


CONCLUSIONS
These data constitute the first solid argument in favor of elective nephrectomy in candidates for a second cadaver renal transplant. Nevertheless, a more thorough study should be carried out of the immunological mechanism involved before recommending this as a general procedure.
Fernández Aparicio
T
T
Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid.
Miñana López
B
B
Polo Villar
G
G
Díaz González
R
R
Fraile Gómez
B
B
Aguirre Benitez
F
F
Morales Cerdán
J M
JM
Leiva Galvis
O
O
D000328:Adult; D002102:Cadaver; D005260:Female; D006084:Graft Rejection / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D009392:Nephrectomy; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome