The Impact of Graft Nephrectomy on Subsequent Transplants: Multivariate Analysis of Risk Factors for Second Graft Loss and for Multiple Transplantations–A Single-Center Retrospective Study

Emmanouil Giorgakis,Asim Syed,Hector Gonzalez

doi:10.5402/2013/362571

Emmanouil Giorgakis, Asim Syed + Show 1 more

Open Access

https://doi.org/10.5402/2013/362571

Copy DOI

Abstract

Introduction. The management of a failed primary allograft remains unclear and the evidence of the effect of transplantectomy to future transplants conflicting. Aim of this study is to review the impact of failed primary graft nephrectomy on future transplants. Materials/Methods. Retrospective study of 101 patients retransplanted in a single institution. Median follow-up was 68 months. Patients were divided into two groups; G1 (n=49) was the nephrectomy group; G2 (n=52) was the graft in situ group. The patients’ and second graft survival were analysed with the Kaplan-Meier method. The patients’ and transplant characteristics were analyzed with student’s t-test. The retransplant risk factors and the risk factors for multiple transplants were obtained via a logistic regression model. Results. The odds of second graft loss post-transplantectomy were high (OR = 5.24). Demographics, HLA mismatch and first graft rejection rates were similar among the two groups and did not affect the outcome. Transplantectomy accelerated the loss of a future failing graft. Multivariate analysis showed transplantectomy as independent risk factor for second allograft loss. Transplantectomy and younger age are significant independent risk factors for future multiple transplants. Conclusion. Transplantectomy of the failed primary graft is an independent risk factor for retransplant loss and for multiple renal transplants.

Highlights

The management of a failed primary allograft remains unclear and the evidence of the effect of transplantectomy to future transplants conflicting
Published studies may be split into two groups, those which found that graft nephrectomy after graft loss was associated with a negative impact on the life of the second transplanted allograft and those suggesting that there was no significant difference in the life of the second allograft among the two groups
The median survival of the failing retransplants was significantly shorter in the nephrectomy group. These findings suggested that even if prior graft nephrectomy does not affect the length of the second graft survival, it does significantly accelerate the pace of the second graft loss should the second graft’s function decline

Summary

Introduction

The management of a failed primary allograft remains unclear and the evidence of the effect of transplantectomy to future transplants conflicting. Aim of this study is to review the impact of failed primary graft nephrectomy on future transplants. Transplantectomy of the failed primary graft is an independent risk factor for retransplant loss and for multiple renal transplants. There has been little research looking at retransplantation in patients with a failed primary kidney transplant and how to achieve the best outcome. Ayus et al looked at 10,000 patients with a failed primary allograft in the United States and found that there was an improvement of morbidity and mortality in the patient group where the allograft was removed [6] These benefits of graft nephrectomy notwithstanding, leaving the primary graft in situ allows avoiding the high surgical risk of such a procedure in an immunosuppressed patient with multiple commorbidities. A recent study by Schleicher et al demonstrated that graft nephrectomy is associated with increased PRAs, worse graft survival after retransplantation and increase rates of primary nonfunction (PNF) and acute rejection; they concluded that

Methods

Results

Discussion

Conclusion