Factors influencing second renal allograft survival: A single center experience in China
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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- 1
The two authors contributed equally to this work.