Tags

Type your tag names separated by a space and hit enter

Long-term outcome of third, fourth and fifth kidney transplantation: technical aspects and immunological challenges.
Clin Kidney J 2019; 12(6):895-900CK

Abstract

Background

The number of patients on waiting lists for repeated kidney transplantation has increased. However, retransplanted patients have a greater surgical and immunological risk than first-time kidney recipients.

Methods

We retrospectively analysed all kidney recipients that underwent third, fourth or fifth kidney transplantation (Group 3+) at the University Hospital Essen, Essen, Germany from October 1973 to January 2017. A historical cohort of recipients retransplanted with a second kidney (Group 2) served as the control. Donor and recipient demographic data, cold ischaemia time (CIT), warm ischaemia time, overall operation time and methods, transplantectomy of previous kidney grafts, incidence of surgical and immunological complications as well as patient- and death-censored survival were analysed.

Results

We identified 108 recipients transplanted with the third, fourth or fifth renal allograft. Patients with more than one transplantation had significantly higher surgical risk due to atherosclerosis (P = 0.002) and higher immunological risk due to higher panel reactive antibody levels preoperatively (current panel reactive antibody P = 0.004; highest panel reactive antibody value P = 0.0001). Group 3+ patients had more often undergone previous transplant nephrectomy (P = 0.0001). There was a significant difference in CIT (P = 0.009), overall operative time (P = 0.0001) and post-transplantation thrombotic events (P = 0.02). We could not demonstrate any differences in graft and patient survival.

Conclusion

Third, fourth and fifth transplant recipients are a high-risk patient cohort. Our results suggest that patient survival after more than three renal transplantations is similar to that of second graft recipients. This supports the concept of repeated kidney retransplantations.

Authors+Show Affiliations

General, Visceral and Transplant Surgery, University Hospital Essen, University Essen-Duisburg, Essen, Germany.General, Visceral and Transplant Surgery, University Hospital Essen, University Essen-Duisburg, Essen, Germany.Department of Nephrology, University Hospital Essen, University Essen-Duisburg, Essen, Germany.General, Visceral and Transplant Surgery, University Hospital Essen, University Essen-Duisburg, Essen, Germany.General, Visceral and Transplant Surgery, University Hospital Essen, University Essen-Duisburg, Essen, Germany.General, Visceral and Transplant Surgery, University Hospital Essen, University Essen-Duisburg, Essen, Germany.General, Visceral and Transplant Surgery, University Hospital Essen, University Essen-Duisburg, Essen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31807305

Citation

Benkö, Tamas, et al. "Long-term Outcome of Third, Fourth and Fifth Kidney Transplantation: Technical Aspects and Immunological Challenges." Clinical Kidney Journal, vol. 12, no. 6, 2019, pp. 895-900.
Benkö T, Halfmann P, Gäckler A, et al. Long-term outcome of third, fourth and fifth kidney transplantation: technical aspects and immunological challenges. Clin Kidney J. 2019;12(6):895-900.
Benkö, T., Halfmann, P., Gäckler, A., Radünz, S., Treckmann, J. W., Kaiser, G. M., & Hoyer, D. P. (2019). Long-term outcome of third, fourth and fifth kidney transplantation: technical aspects and immunological challenges. Clinical Kidney Journal, 12(6), pp. 895-900. doi:10.1093/ckj/sfz014.
Benkö T, et al. Long-term Outcome of Third, Fourth and Fifth Kidney Transplantation: Technical Aspects and Immunological Challenges. Clin Kidney J. 2019;12(6):895-900. PubMed PMID: 31807305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcome of third, fourth and fifth kidney transplantation: technical aspects and immunological challenges. AU - Benkö,Tamas, AU - Halfmann,Patrizia, AU - Gäckler,Anja, AU - Radünz,Sonia, AU - Treckmann,Jürgen W, AU - Kaiser,Gernot M, AU - Hoyer,Dieter P, Y1 - 2019/02/25/ PY - 2018/09/26/received PY - 2019/12/7/entrez PY - 2019/12/7/pubmed PY - 2019/12/7/medline KW - graft survival KW - immunological complications KW - kidney retransplantation KW - patient survival KW - surgical complications SP - 895 EP - 900 JF - Clinical kidney journal JO - Clin Kidney J VL - 12 IS - 6 N2 - Background: The number of patients on waiting lists for repeated kidney transplantation has increased. However, retransplanted patients have a greater surgical and immunological risk than first-time kidney recipients. Methods: We retrospectively analysed all kidney recipients that underwent third, fourth or fifth kidney transplantation (Group 3+) at the University Hospital Essen, Essen, Germany from October 1973 to January 2017. A historical cohort of recipients retransplanted with a second kidney (Group 2) served as the control. Donor and recipient demographic data, cold ischaemia time (CIT), warm ischaemia time, overall operation time and methods, transplantectomy of previous kidney grafts, incidence of surgical and immunological complications as well as patient- and death-censored survival were analysed. Results: We identified 108 recipients transplanted with the third, fourth or fifth renal allograft. Patients with more than one transplantation had significantly higher surgical risk due to atherosclerosis (P = 0.002) and higher immunological risk due to higher panel reactive antibody levels preoperatively (current panel reactive antibody P = 0.004; highest panel reactive antibody value P = 0.0001). Group 3+ patients had more often undergone previous transplant nephrectomy (P = 0.0001). There was a significant difference in CIT (P = 0.009), overall operative time (P = 0.0001) and post-transplantation thrombotic events (P = 0.02). We could not demonstrate any differences in graft and patient survival. Conclusion: Third, fourth and fifth transplant recipients are a high-risk patient cohort. Our results suggest that patient survival after more than three renal transplantations is similar to that of second graft recipients. This supports the concept of repeated kidney retransplantations. SN - 2048-8505 UR - https://www.unboundmedicine.com/medline/citation/31807305/Long-term_outcome_of_third,_fourth_and_fifth_kidney_transplantation:_technical_aspects_and_immunological_challenges DB - PRIME DP - Unbound Medicine ER -