title: Kidney retransplantation in the ipsilateral iliac fossa: a surgical challenge.
abstract: The aim of this study is to review the surgical outcome of kidney retransplantation in the ipsilateral iliac fossa in comparison to first kidney transplants. The database was screened for retransplantations between 1995 and 2013. Each study patient was matched with 3 patients with a first kidney transplantation. Just for graft and patient survival analyses, we added an extra control group including all patients receiving a second transplantation in the contralateral iliac fossa. We identified 99 patients who received a retransplantation in the ipsilateral iliac fossa. There was significantly more blood loss and longer operative time in the retransplantation group. The rate of vascular complications and graft nephrectomies within 1 year was significantly higher in the study group. The graft survival rates at 1 year and 3, 5, and 10 years were 76%, 67%, 61%, and 47% in the study group versus 94%, 88%, 77%, and 67% (p < 0.001) in the first control group versus 91%, 86%, 78%, and 57% (p = 0.008) in the second control group. Patient survival did not differ significantly between the groups. Kidney retransplantation in ipsilateral iliac fossa is surgically challenging and associated with more vascular complications and graft loss within the first year after transplantation. Whenever feasible, the second renal transplant (first retransplant) should be performed contralateral to the prior failed one.
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: L S S
authors.initials: LS
authors.lastname: Ooms
authors.affiliation: Department of Internal Medicine, Division Nephrology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: J I
authors.initials: JI
authors.lastname: Roodnat
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: F J M F
authors.initials: FJ
authors.lastname: Dor
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: T C K
authors.initials: TC
authors.lastname: Tran
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: H J A N
authors.initials: HJ
authors.lastname: Kimenai
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: J N M
authors.initials: JN
authors.lastname: Ijzermans
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Terkivatan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009426:Netherlands; D061646:Operative Time; D016016:Proportional Hazards Models; D012086:Reoperation / Q000379:methods; D012092:Replantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: retransplantation; surgical technique