A third renal transplantation: is it relevant and is it worth it?
BACKGROUND
The aim of this retrospective study was to determine the outcome of third cadaveric renal transplantations performed between 1989 and 2004 among a cohort of 35 patients whose immunosuppression included induction therapy and calcineurin inhibitors. Most patients were highly sensitized with 1 (0-4) HLA (classes I + II) incompatibility between donor and recipient.


RESULTS
The median follow-up time was 57 months (range, 1-190). Fourteen patients experienced delayed graft function that required posttransplantation hemodialysis. The current patient and graft survival rates were 91.4% and 82.8%, respectively. At last follow-up, 6 grafts had been lost: 1 due to primary nonfunction; 1 due to an urinary leak (day 45); 2 deaths with functioning grafts; and 2 chronic allograft nephropathies (CAN) at 85 and 60 months posttransplantation, respectively. Among the 10 patients who experienced acute rejection episodes, half were steroid-sensitive, whereas the others required OKT3 therapy. Overall, when excluding the 2 patients who presented with early loss of their grafts, 13 of 33 patients (39.4%) developed CAN, which led to the graft loss in only 2 cases. The mean creatinine clearance was 57 +/- 23 mL/min at year 5. Of the 35 recipients, 12 (34.3%) developed graft/perigraft complications, among whom 10 (83.3%) required treatment. The most frequent complication was lymphocele (M = 4; 11.4%) or infections that led to rehospitalization (n = 17).


CONCLUSIONS
Results from third transplantations were encouraging. Thus, despite the organ shortage, a third graft was worth it!
Reboux
A H
AH
Department of Nephrology, Dialysis and Multiorgan Transplantation, CHU Rangueil, Toulouse, France.
Kamar
N
N
Fort
M
M
Rischmann
P
P
Malavaud
B
B
Cointault
O
O
Abbal
M
M
Durand
D
D
Rostaing
L
L
D000328:Adult; D002102:Cadaver; D005260:Female; D005602:France; D006085:Graft Survival; D006680:HLA Antigens; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D009392:Nephrectomy; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D006435:Renal Dialysis; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors
D006680:HLA Antigens; D007166:Immunosuppressive Agents