title: Ten-Year Follow-up of a Reused Kidney Graft for Transplant Using Sirolimus for Maintenance Immunosuppression.
abstract: Reused kidney grafts have been transplanted with successful outcomes, though not widely performed in the Unites States. We present the case of a reused kidney graft with 10-year follow-up. The first donation was from a patient who died from a cerebrovascular accident and whose organs were used for a simultaneous pancreas and kidney transplant. After 5 years, the patient died and kidney was considered for donation and reuse. The patient had a virtual crossmatch with the first donor and a complement-dependent and flow-dependent crossmatch with the second donor. Long-term immune suppression was kept with a calcineurin-inhibitor-free regimen with sirolimus to prevent further damage from the first recipient. Control kidney biopsy showed steady progression of previous CNI toxicity without further damage. We describe the immunological basis of reused graft, the technical aspects of procurement and transplantation, as well as the use of Mammalian target of rapamycin for maintenance immunosuppression with good long-term results. Reused kidney grafts can be a good source of kidney grafts when adequate selection between donor and recipients is made and immunosuppression protocol is tailored to the preexisting damage to the original graft.
authors.affiliation: The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida. Electronic address: alejandro.lugo.b@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Lugo-Baruqui
authors.affiliation: The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida.
authors.forename: G W
authors.initials: GW
authors.lastname: Burke
authors.affiliation: The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida.
authors.forename: G
authors.initials: G
authors.lastname: Guerra
authors.affiliation: Department of Surgery and Pathology, Transplantation Laboratories and Immunopathology, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: P
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida.
authors.forename: G
authors.initials: G
authors.lastname: Ciancio
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D005544:Forecasting; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus