Simultaneous transplant nephrectomy and ipsilateral second graft retransplantation

Area of Science:

• Nephrology
• Transplant Surgery
• Immunology

Background:

• Chronic rejection is a significant cause of kidney graft loss.
• Retransplantation is a viable option for patients experiencing graft failure.
• Simultaneous procedures may offer advantages in specific clinical scenarios.

Purpose of the Study:

• To evaluate the safety and efficacy of simultaneous transplant nephrectomy and retransplantation in the ipsilateral iliac fossa.
• To assess graft survival and patient morbidity following a second kidney transplant in the same anatomical location.
• To compare outcomes with historical data for kidney retransplantation.

Main Methods:

• Presentation of six cases undergoing simultaneous native kidney nephrectomy and ipsilateral iliac fossa retransplantation.
• Utilized previous lower quadrant incision and graft vascular stumps when feasible.
• Reestablished urinary tract continuity using Politano-Leadbetter ureteroneocystostomy.
• Follow-up ranged from 41 to 100 months post-second transplant.

Main Results:

• All primary kidney grafts were lost due to chronic rejection.
• Graft survival rates for the second transplant were comparable to those in the contralateral fossa.
• No increased morbidity was observed in the six cases presented.
• Successful urinary tract reconstruction was achieved in all patients.

Conclusions:

• Simultaneous transplant nephrectomy and retransplantation in the ipsilateral iliac fossa is a safe and effective procedure.
• This approach offers comparable graft survival to retransplantation in a new site.
• The technique avoids increased patient morbidity and utilizes existing surgical access.