The Effect of Transplant Nephrectomy On Allosensitisation and Time to Retransplantation.

Abstract

Lack of consensus exist on the impact of recipient nephrectomy on sensitization to donor antigens and future transplant outcomes.This retrospective study analysed all recipient nephrectomies (Group-N) performed between 1988-2009 at our centre and compared to patients with a failed transplant and no nephrectomy (N0). There were total 207 kidney transplant recipients (KTRs) who were relisted after a failed transplant of whom 86 (41%) underwent graft nephrectomy. Patients with graft nephrectomy had higher levels of HLA presensitization detected by Luminex screening prior to the subsequent renal transplant.The mean calculated PRA was significantly higher for Group N compared to Group-N0 (Group-N,62±42;Group N-0,53.9±4;P=0.02;Mann Whitney U test). When analysed as a cumulative number of detected antibody specificities, again, Group-N had significantly higher specificities detected on the Luminex platform (Group N,18.5; Group-N0,11.6; P=0.02; Mann Whitney U test). Patients in Group-N0 had slightly lower cumulative anti-donor HLA specific antibodies to the failed graft when compared to the Group-N (Group-N0 1.07,Group-N 1.34; P=0.3). Of the 86 patients with nephrectomy data for pre and post nephrectomy HLA antibodies was available for 43 and in these patients; there was a significant increase in the cumulative HLA antibody specificities post-nephrectomy( cumulative HLA specific antibody specificities; pre nephrectomy 4.2 vs. post nephrectomy 12.1, P<0.0001). When total DSA specificities were analysed based on the timing of nephrectomy, patients with nephrectomy within 30 days of transplantation had significantly lower cumulative DSA specificities compared to those who had nephrectomy after 30 days (cumulative DSA specificities, nephrectomy<30 days, 1.0 vs.nephrectomy>30 days 12.1, P=0.03).Despite the higher levels of HLA allosensitization in the nephrectomy group, there was no significant difference in the time to re-transplantation in these relisted KTRs. Despite the higher levels of presensitization as determined by the PRA, KTRs who underwent nephrectomy (Group-N) had comparable incidence of early acute rejection (Group N, 14.9%; Group-N0, 17.7%, P=Ns) DGF (Group-N, 32.8%; Group-N0, 35.4%; P=Ns) and their graft survival at 1 yr was also comparable to those without nephrectomy. In conclusion, recipient graft nephrectomy is associated with higher levels of allosensitization but not associated with adverse clinical outcomes following the subsequent transplantation.