Kidney retransplantation from HLA‐incompatible living donors: A single‐center study of 3rd/4th transplants

• Published in: Clinical transplantation Vol. 31; no. 11
• Main Authors: Barnes, James C.H., Goodyear, Stephen J., Imray, Caitlin E.A., Lam, For Tai, Kashi, Habib S., Tan, Lam Chin, Higgins, Robert, Imray, Christopher H.E.
• Format: Journal Article
• Language: English
• Published: Denmark 01-11-2017
• Subjects: Adult; Case-Control Studies; complications; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Graft Survival; Histocompatibility Testing; HLA‐incompatible transplantation; Humans; Kidney Failure, Chronic - surgery; Kidney Function Tests; kidney retransplantation; Kidney Transplantation; Living Donors; Male; Postoperative Complications - prevention & control; Prognosis; Registries; Reoperation; Risk Factors; Survival Rate; Tissue and Organ Procurement - methods; United Kingdom - epidemiology; graft survival; kidney retransplantation; HLA-incompatible transplantation; complications
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13104

Background
The demand for kidney retransplantation following graft failure is rising. Repeat transplantation is often associated with poorer outcomes due to both immunological and surgical challenges. The aim of this study was to compare surgical and functional outcomes of kidney retransplantation in recipients that had previously had at least two kidney transplants with a focus on those with antibody incompatibility.
Methods
We analyzed 66 patients who underwent renal transplantation at a single center between 2003 and 2011. Consecutive patients receiving their 3rd or 4th kidney were case‐matched with an equal number of 1st and 2nd transplants.
Results
Twenty‐two 3rd and 4th kidney transplants were matched with 22 first and 22 seconds transplants. Operative times and length of stay were equivalent between the subgroups. Surgical complication rates were similar in all groups (22.7% in 1st and 2nd transplants, and 27.2% in 3rd/4th transplants). There was no significant difference in patient or graft survival over 5 years. Graft function was similar between transplant groups at 1, 3, and 5 years.
Conclusions
Third and fourth kidney transplants can be performed safely with similar outcomes to 1st and 2nd transplants. Kidney retransplantation from antibody‐incompatible donors may be appropriate for highly sensitized patients.