Elsevier

Transplant Immunology

Volume 20, Issue 3, January 2009, Pages 150-154
Transplant Immunology

Factors influencing second renal allograft survival: A single center experience in China

https://doi.org/10.1016/j.trim.2008.09.010Get rights and content

Abstract

Second renal transplants are historically associated with a poor prognosis. The aim of the present study was to assess long-term survival of second renal grafts from deceased donors performed at our center and to analyze risk factors associated with long-term graft outcome. Sixty-five second renal grafts were enrolled into this study, and compared to primary ones performed during the same period. Kaplan–Meier curve showed a graft survival rate of 89.2% at 1 year, 80% at 3 years, and 63.1% at 5 years, which were similar to that of primary graft. Univariate analysis showed that time to first graft loss, cold ischaemia time, HLA mismatch, primary maintenance immunosuppressant, acute rejection episodes, and serum creatinine at 1 year were significantly associated with regraft survival. Cox regression demonstrated the dominant effect of acute rejection episodes, primary maintenance immunosuppressant, serum creatinine at 1 year, and time to first graft loss as predictor of second graft outcome. However, when long-term survival of second graft was examined on the basis of Kaplan–Meier estimates, HLA mismatch was found to be significant. The second graft had more benefits of improved pre-transplant screening and post-transplant management, and its survival rate was satisfactory and similar to that of primary one. Immunologic factors such as acute rejection and primary immunosuppressant are the main determinants of long-term renal transplantation outcome.

Introduction

Emergence of new immunosuppressive agents has markedly reduced the incidence of acute rejection but has little effect on chronic graft dysfunction. Long-term renal allograft survival continues to be an area of concern [1]. Therefore, more and more renal transplant recipients cycled back through renal replacement therapy and allograft failure is now one of the leading causes of being listed for transplant. Second renal allograft recipients have already suffered graft loss and been exposed to alloantigens. Most of them are highly sensitized, tending to make rejection more frequent despite a negative crossmatch. Previous studies have shown that regraft survival rate for deceased donor renal transplantation was lower than that of primary allograft recipients [2], [3]. Therefore, controversy exists about whether patients experiencing primary allograft loss should be offered the second renal allograft. This is an issue that has been heightened by exponential rise in patients awaiting transplantation compared with the number of transplants performed each year.

Renal transplantation improves life expectancy for patients with end-stage renal disease (ESRD), compared with remaining on dialysis [4]. Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and non-diabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure [5]. Furthermore, the success rates for renal retransplantation have significantly improved in recent years. It is reported that long-term graft survival rates for second renal transplants approach those of primary transplantation [6]. The quality of life of recipients of successful renal transplants is superior to that of patients on dialysis [7]. Therefore, those patients should not been deprived of the opportunity to receive the second renal allograft.

Risk factors for graft loss of renal retransplantation have been well investigated; however, different even contradictory results have been reported [8], [9], [10], [11]. The purposes of the present study were to evaluate the patient and graft survival rates in the second renal transplantation at our centre, to analyze the different factors which might affect graft survival in this group of patients. This may be helpful for the determination of optimal transplant timing, management and patient selection criteria of retransplantation.

Section snippets

Patients

From January 1997 to December 2002, 678 kidneys were transplanted from deceased donors in our center. During the same period, 65 patients received their second renal graft and were enrolled into this study. All the patients on the waiting list were carefully monitored on out-patient clinic. The presence of anti-HLA antibodies were tested systematically every 3 months, which was determined by ELISA technology (LAT-M, One Lambda Inc., CA, USA). Lest the candidate recipients be sensitized, blood

Population characteristics

Between January 1997 to December 2002, 65 retransplantations were performed at our center, corresponding to 9.6% of 678 renal transplants. On average, 11 retransplantations were performed annually. Compared with recipients of primary grafts, more male recipients were observed in those of second graft (70.8% vs. 54.2, P = 0.012). The mean (SD, range) duration of previous allograft function was 68.8 (40.1, 11–205) months. Sixteen patients suffered first allograft nephrectomy mainly for fever, graft

Discussion

Given the shortage of deceasing renal donations, it is necessary to assess long-term outcome of second grafts and to identify risk factors associated with long-term graft survival in order to determine whether patients experiencing first graft loss should be transplanted a second one. In this paper, we report a single center outcome of 65-second renal grafts performed between 1997 and 2002. To identify significant factors associated with graft survival, these data was analyzed in detail and

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  • Cited by (0)

    1

    The two authors contributed equally to this work.

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