title: Single-center experience with third and fourth kidney transplants.
abstract: Kidney retransplantation is often associated with a higher immunological risk than is primary renal transplantation. Faced with increasing organ shortage and growing waiting lists, results of kidney retransplantation are of particular interest. Fifty-six third and fourth kidney transplants were analyzed retrospectively. Parameters included patient and donor demographics, operative details, incidence of surgical, immunological and infectious complications and patient and graft survival. Patients receiving third kidney grafts had 1- and 5-year patient/graft survival rates of 97.4%/72.9% and 88.9%/53.6%, respectively. Episodes of acute rejection and delayed graft function were observed in 44% and 49% of these patients. Fourth kidney transplantation was associated with 1- and 2-year patient/graft survival rates of 84.8%/68.5% and 63.6%/47%, respectively. Acute rejection and delayed graft function occurred in 33% and in 60% of cases. Acceptable patient and graft survival may be achieved after third and fourth kidney transplantation. Graft losses in this sensitized population are mainly because of rejection. Profound immunosuppression may lead to major infectious problems.
authors.affiliation: Center for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria. katrin.kienzl@i-med.ac.at
authors.forename: Katrin
authors.initials: K
authors.lastname: Kienzl-Wagner
authors.forename: Walter
authors.initials: W
authors.lastname: Mark
authors.forename: Manuel
authors.initials: M
authors.lastname: Maglione
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.forename: Robert
authors.initials: R
authors.lastname: Öllinger
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Claudia
authors.initials: C
authors.lastname: Bösmüller
mesh_terms: D000328:Adult; D015897:Comorbidity; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome