title: Impact of surgical procedures and complications on outcomes of third and subsequent kidney transplants.
abstract: BACKGROUND
  Surgical procedures and complications have rarely been described in patients receiving a third or subsequent renal transplant.
  
  
  METHODS
  Data from 61 consecutive third (n=56), fourth (n=4), and fifth (n=1) renal transplants performed during 1974 to 2005 were analyzed retrospectively.
  
  
  RESULTS
  Actuarial graft survival was 91%, 74%, and 57% at one, five, and 10 years, respectively. Technical failure accounted for the loss of three grafts (5%). A transperitoneal approach was necessary in 41% of patients. Technical difficulties occurred in half of the procedures, mainly due to atheroma or vascular calcifications. Overall, there were 45 surgical complications in 30 patients, of urological (n=11), vascular (n=6), infectious (n=9), hemorrhagic (n=12), digestive (n=3), or wound origin (n=4). The rate of surgical revision was 16%. Univariate analysis showed that among surgical complications, only vascular complications were associated with a poor graft outcome (P=0.02). Urological complications did not influence long-term graft outcome. Multivariate analysis of all surgical procedures and complications that might have influenced graft survival showed that only vascular complications were associated with a poorer graft outcome (relative risk=6.13, P=0.015).
  
  
  CONCLUSIONS
  Despite a high rate of surgical complications and revisions, third and subsequent kidney transplantations may be performed safely by experienced surgeons without surgical complications influencing long-term graft outcome.
authors.affiliation: Service de Transplantation Rénale, Hôpital Necker, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Loupy
authors.forename: Dany
authors.initials: D
authors.lastname: Anglicheau
authors.forename: Marc Olivier
authors.initials: MO
authors.lastname: Timsit
authors.forename: Eric
authors.initials: E
authors.lastname: Thervet
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Mamzer-Bruneel
authors.forename: Frank
authors.initials: F
authors.lastname: Martinez
authors.forename: François
authors.initials: F
authors.lastname: Desgranchamps
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thiounn
authors.forename: Henri
authors.initials: H
authors.lastname: Kreis
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Yves
authors.initials: Y
authors.lastname: Chrétien
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D015996:Survival Rate; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000150:complications / Q000601:surgery