Influence of the First Graft Nephrectomy in the Evolution of Second Kidney Transplant

Abstract

Introduction: Nephrectomy is usually specified after the loss of a graft when there are signs of intolerance or resistance to erythropoietin. However, the influence of the first graft nephrectomy in the evolution of the second graft is less known. Materials and methods: We conducted a multicenter study of all second transplants performed between January 2001 and December 2005 in 15 centers in our country. Were analyzed: Data from the first graft (donor and recipient age, pretransplant antibody(Ac) titres, rejection acute rate, acute tubular necrosis(ATN), immunosupression, causes of graft loss) Indication of nephrectomy, second transplant data (pretransplant Ac title, acute rejection rate, inmunospresión, ATN, yearly development of proteinuria and renal function and patient and graft survival. The minimum follow-up period is 5 years Results: The sample consists of 525 patients who received a second kidney transplant, 243 had been nephrectomized, in 25 had been performed an embolization and 258 continued with the first graft. The indication for nephrectomy/embolization was 31.5% for graft intolerance in 38.16% by early nephrectomy and required rest from other causes.No nephrectomy for resistance to erythropoietin were made. In the first graft did not find significant differences in donor age, the title of Ac at transplantation, acute rejection rate or frequency of ATN among patients with or without nephrectomy. The duration of first graft was 31.8 months in patients nephrectomized and 94.9 in which nephrectomy was not required. The waiting time for the second transplant was higher in patients nephrectomized (33 vs 23 months, p< 0,01) In the second graft did not find significant differences in donor age, cause of donor death, recipient age or number of HLA incompatibilities in patients with or without prior nephrectomy. The nephrectomized patients had a significantly higher second pretransplant Ac (15.7 vs. 11.8%, p < 0.001), increased frequency of NTA (54% vs. 39%, p < 0.001) and higher rate of acute rejection (24, 7 vs. 17.1%, p < 0.001), as well as more frequently required the use of induction therapy (55 vs 41%, p < 0.01). There were no significant differences in patient survival or graft survival after 5 years of follow-up Conclusions: Nephrectomy was performed in 50.9% of grafts lost. It is indicated by early nephrectomy and graft intolerance syndrome. It is associated with: Increased waiting on dialysis, increased pre-second transplant antibodies, more NTA, more acute rejection, further immunosuppression. No impact on graft and patient survival was observed at 5 years of follow-up.