Third and fourth kidney transplant: still a reasonable option

Area of Science:

• Nephrology
• Transplantation Surgery
• Immunology

Background:

• Second kidney transplants are established for graft failure patients, with survival comparable to first transplants.
• The efficacy of third and fourth kidney transplants versus continued dialysis remains a subject of debate.
• This study evaluates outcomes for patients undergoing third and fourth renal replacement therapy.

Purpose of the Study:

• To analyze graft and patient survival rates for third and fourth kidney transplantations.
• To identify variables associated with outcomes in repeat kidney transplant recipients.
• To assess surgical complications in third and fourth kidney transplant procedures.

Main Methods:

• Prospective data collection from July 1985 to December 2008 for 74 third and 8 fourth kidney transplantations.
• Analysis of variables including patient demographics, dialysis duration, graft origin, and surgical procedures.
• Evaluation of graft survival, patient survival, and operative complications.

Main Results:

• Third and fourth transplantations showed 1-year patient survival of 92.7% and 85.7%, respectively.
• 1-year graft survival rates were 88% for third and 71.4% for fourth transplantations.
• Common complications included acute tubular necrosis (35.4%) and acute rejection (17.1%); however, these were not independent prognostic factors.

Conclusions:

• Third and fourth kidney transplantations represent a valid therapeutic option.
• These repeat transplantations offer reasonable short- and long-term patient and graft survivals.
• An iliac fossa approach was preferred for most transplantations, with orthotopic transplantation reserved for select cases.