Equivalent outcomes with primary and retransplantation in African-American deceased-donor renal allograft recipients.
BACKGROUND
Graft survival following renal retransplantation has been inferior to that following primary allografting, particularly in African Americans (AAs) receiving deceased-donor (DD) kidneys.


METHODS
Among 166 AA DD renal allograft recipients transplanted from July 2001 through July 2007, we compared the outcomes of 26 (16%) receiving a second graft with those of 140 primary cases. All patients received either thymoglobulin (ATG) or an IL-2 receptor antagonist for induction, and were maintained on either tacrolimus or sirolimus + mycophenolate mofetil +/- prednisone.


RESULTS
When compared with primary transplants, regrafts received kidneys from older donors, were younger, more sensitized, more likely to receive ATG and to be maintained on prednisone, received more doses of ATG, and were less likely diabetic. There was no difference between primary and retransplant groups in overall patient or graft survival; incidence of acute rejection, CMV infection, BK nephropathy, or new-onset diabetes mellitus; and serum creatinine at 1 year.


CONCLUSIONS
AA renal allograft recipients can undergo a second DD transplant with intermediate-term outcomes comparable to that of a primary graft, despite the presence of multiple immunologic and non-immunologic high-risk factors, by extending the course of ATG induction and continuing prednisone therapy in the vast majority of cases.
Gruber
Scott A
SA
Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA. sgruber@dmc.org
Brown
Kristian L
KL
El-Amm
Jose M
JM
Singh
Atul
A
Mehta
Kalyani
K
Morawski
Katherina
K
Cincotta
Elizabeth
E
Nehlsen-Cannarella
Sandra
S
Losanoff
Julian E
JE
West
Miguel S
MS
Doshi
Mona D
MD
D000328:Adult; D001741:Black or African American; D005260:Female; D006085:Graft Survival; D006684:HLA-DR Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D014184:Transplantation, Homologous
D006684:HLA-DR Antigens