Surgical aspects of third and subsequent renal transplants performed by the extraperitoneal access.
BACKGROUND
We reviewed our experience with third, fourth, and fifth renal transplants performed by the extraperitoneal access.


METHODS
The charts of 21 third and subsequent transplants performed extraperitoneally were reviewed. Surgical aspects, the occurrence of rejection episodes, delayed graft function (DGF), graft and patient survival were evaluated and compared with 1560 first transplants in adults with nonmanipulated fossa performed in the same period.


RESULTS
Transfusion was necessary in 52% of the retransplants and in 5.7% of the first transplants (P<0.0001). Mean operative time was 327 min for retransplants and 212 min for first transplants (P<0.0001). Surgical complications occurred in 4 patients (19%): two arterial thrombosis and two ureteral obstructions. DGF occurred in 11 patients (52%) among retransplants and in 453 (29%) among first transplants (P=0.028). Acute rejection occurred in 7 (33.3%) retransplants and in 530 first transplant patients (33.9%). The mean serum creatinine among retransplant patients 30 days and one year after transplantation was 2.5 mg/dl and 1.8 mg/dl. One-year graft survival was 57.1% (75% for live and 46% for cadaver donors) for retransplants and 86% for first transplant patients (P<0.0001).


CONCLUSIONS
Third and subsequent transplants performed extraperitoneally are more time-consuming and require more transfusions in the perioperative period. A higher but acceptable incidence of arterial thrombosis and urinary obstruction were observed. One-year graft survival was better with live donor grafts, but was still lower when compared with first transplants using the same surgical technique.
Mazzucchi
Eduardo
E
Renal Transplantation Unit, Division of Urology, University of São Paulo Medical School, Rua Apiacás 621, ap. 121, 05017-020 São Paulo, Brazil. mazuchi@terra.com.br
Danilovic
Alexandre
A
Antonopoulos
Ioannis Michel
IM
Piovesan
Afonso Celso
AC
Nahas
William Carlos
WC
Lucon
Antonio Marmo
AM
Srougi
Miguel
M
D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology
D003404:Creatinine