title: Impact of transplant nephrectomy on retransplantation: a single-center retrospective study.
abstract: OBJECTIVE
  Kidney retransplantation is the best treatment option for transplanted patients returning to dialysis. The aim of this study was to explore the effect of removal of a failed graft on the outcome of a subsequent transplant.
  
  
  METHODS
  We identified 140 patients who underwent retransplantation at our institution. Retrospective comparison was performed between patients undergoing kidney retransplantation with (group A, n = 28) and without (group B, n = 112) preliminary nephrectomy. Graft and patient survival were calculated by the Kaplan-Meier method.
  
  
  RESULTS
  After a mean follow-up of 64.5 months, patients survival was comparable between the two groups (group A = 68.6 vs. group B = 63.5 months; p = 0.6). Mean graft survival was 65.5 versus 56.0 months in group A and B, respectively (p = 0.14). Surgical complications after retransplantation were significantly higher in group A compared to group B (57.1 vs. 19.6 %; p = 0.0002). There was no significant difference between the two groups in the panel reactive antibody level at the time of retransplantation (group A = 20 % vs. group B = 32 %; p = 0.22). The acute rejection rate was 35.7 % in group A and 25 % in group B (p = 0.36). The risk of delayed graft function was not significantly increased in group A (p = 0.63). Finally, 2 years after retransplantation, patients who had not undergone nephrectomy had lower serum creatinine concentrations (1.3 vs. 1.7 mg/dl; p = 0.01) and higher estimated GFR (77.9 vs. 59.3 ml/min/1.73 m(2); p = 0.02).
  
  
  CONCLUSIONS
  Our experience shows that there is no advantage in performing allograft nephrectomy before retransplantation, and that this procedure does not seem to significantly influence the survival of a subsequent graft.
authors.affiliation: Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy. giuseppe.lucarelli@inwind.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Vavallo
authors.forename: Carlo
authors.initials: C
authors.lastname: Bettocchi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Losappio
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandaliano
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Selvaggi
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ditonno
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000502:physiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D051437:Renal Insufficiency / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult