title: Impact of transplant nephrectomy on peak PRA levels and outcome after kidney re-transplantation.
abstract: OBJECTIVE
  To determine the impact of transplant nephrectomy on peak panel reactive antibody (PRA) levels, patient and graft survival in kidney re-transplants.
  
  
  METHODS
  From 1969 to 2006, a total of 609 kidney re-transplantations were performed at the University of Freiburg and the Campus Benjamin Franklin of the University of Berlin. Patients with PRA levels above (5%) before first kidney transplantation were excluded from further analysis (n = 304). Patients with graft nephrectomy (n = 245, NE+) were retrospectively compared to 60 kidney re-transplants without prior graft nephrectomy (NE-).
  
  
  RESULTS
  Peak PRA levels between the first and the second transplantation were higher in patients undergoing graft nephrectomy (P = 0.098), whereas the last PRA levels before the second kidney transplantation did not differ between the groups. Age adjusted survival for the second kidney graft, censored for death with functioning graft, were comparable in both groups. Waiting time between first and second transplantation did not influence the graft survival significantly in the group that underwent nephrectomy. In contrast, patients without nephrectomy experienced better graft survival rates when re-transplantation was performed within one year after graft loss (P = 0.033). Age adjusted patient survival rates at 1 and 5 years were 94.1% and 86.3% vs 83.1% and 75.4% group NE+ and NE-, respectively (P < 0.01).
  
  
  CONCLUSIONS
  Transplant nephrectomy leads to a temporary increase in PRA levels that normalize before kidney re-transplantation. In patients without nephrectomy of a non-viable kidney graft timing of re-transplantation significantly influences graft survival after a second transplantation. Most importantly, transplant nephrectomy is associated with a significantly longer patient survival.
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Dietlind
authors.initials: D
authors.lastname: Tittelbach-Helmrich
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Offermann
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Geyer
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Thomusch
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Ulrich Theodor
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
keywords: Graft nephrectomy; Kidney re-transplantation; Panel reactive antibodies, Patient and graft survival