Immunologic and non-immunologic complications of a third kidney transplantation.
OBJECTIVE
Patients who undergo repeat kidney transplantations (KTs) are considered at high risk for experiencing immunologic and non-immunologic complications. In this study, we investigated the clinical outcomes, including medical and surgical complications, of patients who underwent a third KT at our center.


METHODS
Between March 1969 and December 2012, a total of 2,110 KTs were performed at the Seoul St. Mary's Hospital. Of them, we examined 11 patients who underwent a third KT, and investigated the allograft outcomes and complication rates.


RESULTS
The mean follow-up duration after KT was 72.4 ± 78.3 months. The mean age at KT was 38.2 ± 8.0 years, and seven patients (63.6%) were males. Nine patients (81.8%) underwent living-donor KT. A cross-match test yielded positive results in four of the nine patients, and all underwent pretransplant desensitization therapy. After KT, three patients (27.2%) showed delayed graft function. Acute rejection developed in four patients (36.4%), and surgical complications that required surgical correction occurred in three patients. Allograft failure developed due to acute rejection (n = 3) or chronic rejection (n = 1) in four patients. Allograft survival rates at 1, 5, and 10 years were 81.8%, 42.9%, and 42.9%, respectively; however, the allograft survival rate at 5 years was > 80% in patients who underwent KT only after results of the panel reactive antibody test became available.


CONCLUSIONS
Thus, a third KT procedure may be acceptable, although aggressive pretransplant immune monitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications.
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Hyun Seon
HS
Kim
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Jae Young
JY
Kim
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Eun Jin
EJ
Kang
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Yoon Seok
YS
Choi
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Ji-Il
JI
Kim
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
In Sung
IS
Moon
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Bum Soon
BS
Choi
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Cheol Whee
CW
Park
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Chul Woo
CW
Yang
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Yong-Soo
YS
Kim
Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.|Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Byung Ha
BH
Chung
D000208:Acute Disease; D000328:Adult; D064591:Allografts; D002908:Chronic Disease; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012086:Reoperation; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
Allograft survival; Complication; Kidney transplantation; Retransplantation