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Renal retransplantation. The Johannesburg Hospital experience
Insights
Renal retransplantation outcomes were analyzed between 1968 and 1985. Graft survival rates were 52.8% at 1 year and 40.5% at 5 years, supporting retransplantation justification.
Area of Science:
- Nephrology
- Transplantation Immunology
Background:
- Renal transplantation is a critical treatment for end-stage renal disease.
- Retransplantation, or receiving a subsequent kidney allograft, is an option for patients whose initial graft has failed.
Purpose of the Study:
- To evaluate the outcomes of renal retransplantation.
- To identify factors influencing the survival of second, third, and fourth kidney allografts.
Main Methods:
- Retrospective analysis of 108 renal retransplants performed between 1968 and 1985 at Johannesburg Hospital.
- Actuarial graft survival rates calculated at 1 and 5 years.
- Analysis of factors including previous graft survival, cyclosporin A use, pre-sensitization, original renal disease, and patient sex.
Main Results:
- Actuarial graft survival rates were 52.8% at 1 year and 40.5% at 5 years.
- Key factors influencing survival included prior graft duration, cyclosporin A, pre-formed antibodies, original disease (diabetes, analgesic nephropathy), and patient sex.
- Outcomes were comparable to those reported for first kidney allografts.
Conclusions:
- Renal retransplantation demonstrates acceptable graft survival rates.
- Retransplantation is a viable and justified option for patients with failed kidney allografts.
- Understanding influencing factors can help optimize patient selection and post-transplant management.
Abstract:
Between 1968 and 1985 108 renal retransplants were performed at Johannesburg Hospital; 102 patients received a second, 5 patients a third, and 1 patient a fourth kidney. The actuarial graft survival at 1 and 5 years is 52.8% and 40.5%. All retransplanted kidneys were obtained from cadaver donors. Factors that influence second graft survival are the period of survival of the previous graft, the use of cyclosporin A, the level of pre-sensitisation determined by preformed antibodies, the original disease (in particular diabetes and analgesic nephropathy) and the patient's sex. The results of retransplantation are not significantly different from those found in patients with first allografts; hence retransplantation is justified in those individuals whose previous donor kidney has ceased to function.