Assessment of Long-Term Outcomes After Kidney Retransplantation.

Abstract

[Introduction] In recent years it has become possible to prevent antibody-mediated rejection by performing desensitization with a combination of preoperative plasma exchange, rituximab (RIT), and g-globulin (IVIG).In the present study we assessed the long-term outcome of initial kidney transplantation and retransplantation. [Subjects and Methods] Between 2001 and 2013 kidney transplantation was performed in 1026 cases (initial kidney transplantation: 965 cases; kidney retransplantation: 61 cases) in the Department of Urology of Tokyo Women's Medical University. The assessment was conducted by dividing the cases into an initial kidney transplantation group and a kidney retransplantation group and comparing them. [Results] No significant differences between the groups were seen in their 1-year, 5-year, or 10-year graft survival or patient survival rates, and no significant differences were seen in their serum creatinine values. The pre-transplantation donor-specific antibody (DSA)-positive rate was 169/965 (18%) in the initial transplantation group and 22/61 (36%) in the retransplantation group, and DSA-positive cases tended to be more common in the retransplantation group. The rate of occurrence of chronic antibody-mediated rejection was higher in the retransplantation group, and the difference in rejection rates was significant. The frequency of de novo detection was 31/965 (3%) in the initial transplantation group and 1/61 (2%) in the retransplantation group, and it tended to be higher in the initial transplantation group. [Conclusion] By performing an adequate preoperative immunologic evaluation with flow cytometry crossmatch (FCXM), Luminex, etc., and performing preconditioning when necessary, it appeared possible to achieve outcomes that are not inferior to the outcomes of initial transplantation.