Impact of graft nephrectomy on outcomes of second kidney transplantation.
OBJECTIVE
To determine the impact of renal graft nephrectomy on second kidney transplantation survival.


METHODS
We carried out a retrospective single-center study by analyzing cases performed from January 2000 to December 2011. Retransplanted patients who underwent previous allograft nephrectomy more than 3 months post-transplantation (group 1) were compared with those who did not (group 2) in terms of graft survival, incidences of acute rejection and delayed graft function. Multivariate Cox proportional hazard models were used to assess risk factors of graft loss after retransplantation.


RESULTS
Overall, 146 patients were analyzed, including 52 (35.6%) in group 1 and 94 (64.4%) in group 2. Group 1 patients presented a significantly shorter first graft survival (0.8 vs 8.6 years, P < 0.001) and more anti-class I antibodies (90.5% vs 74.2%, P = 0.03). A total of 10 patients (19%) in group 1 and 16 patients (17%) in group 2 had at least one acute rejection episode (P = 0.74). Delayed graft function was observed in 13 patients (25%) in group 1 and 17 patients (18%) in group 2 (P = 0.32). Graft survival at 1, 5 and 10 years was, respectively, 94%, 81% and 58% in group 1, and 99%, 93% and 66% in group 2 (P = 0.10). Graft survival was decreased by increased donor age and serum creatinine, and tended to be associated with post-transplantation presence of anti-class I and II antibodies. Graft nephrectomy was not associated with graft survival in multivariate analysis.


CONCLUSIONS
Graft nephrectomy, probably a marker of high immunological risk patients, is not a risk factor of increased retransplant failure.
Department of Urology and Transplantation, University Hospital of Montpellier, Montpellier, France.
Saâd Ed-Dine
SE
Fadli
Vincent
V
Pernin
Erika
E
Nogue
Valérie
V
Macioce
Marie-Christine
MC
Picot
Annie
A
Ramounau-Pigot
Valérie
V
Garrigue
François
F
Iborra
Georges
G
Mourad
Rodolphe
R
Thuret
D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012086:Reoperation; D012189:Retrospective Studies
acute renal failure; graft nephrectomy; graft survival; kidney transplantation