Renal Retransplantation in Simultaneous Pancreas Kidney Transplant Recipients

W. Shields, J. Zimmerman, P. Mohan, F. Nooh, D. Hickey.

National Renal and Pancreatic Transplantation Unit, Beaumont Hospital, Dublin, Ireland.

Meeting: 2015 American Transplant Congress

Abstract number: C209

Keywords: Allocation, Cadaveric organs, Kidney, Resource utilization

Introduction:Simultaneous Pancreas Kidney Transplantation(SPK) is standard of care in selected patients with end stage renal failure secondary to diabetes mellitus. There is little literature examining renal retransplantation after graft loss in SPK recipients. This study reviews our experience of renal retransplantation in SPK patients with loss of their first kidney.

Materials&Methods:A retrospective study was conducted on all patients with SPK transplants at a single centre in Ireland between 1992 and 2014. Timing of transplant, duration of functioning renal graft, timing of graft failure, panel reactive antibody (PRA), cause of graft failure, timing of second renal transplant, outcomes, and technical aspects of the surgery were recorded for analysis.

Results:11 SPK patients underwent renal retransplantation after failure of their original renal graft. Cause of graft failure in all patients was chronic allograft nephropathy/calcineurin toxicity. All patients underwent transplant nephrectomy at the time of transplantation and received deceased donor kidneys. Kidneys were allocated purely on ABO compatibility.

Deatails of Renal Retransplanted Patients

Patient	SPK Date	Date of Kidney Failure	Date of ReTransplant	Creat@1 month	Creat@12 months	Follow up months
1	12/31/90	06/30/00	5/12//03	147	120	132
2	03/08/94	04/30/98	10/23/02	166	174	133
3	07/20/95	11/09/98	10/26/99	118	120	103
4	08/04/94	11/11/03	12/26/03	136	128	118*
5	08/20/95	07/01/04	09/02/07	70	100	136
6	10/24/95	02/01/02	06/01/02	109	79	228
7	07/10/98	07/26/04	05/12/2006	161	109	170*
8	04/07/04	21/20/12	03/05/13	117	97	115*
9	07/09/02	08/09/13	15/10/13	135	120	144
10	08/12/2003	12/10/12	25/12/13	140	156	1*
11	17/04/2004	18/10/13	02/05/14	122	120	5

*Death with Functioning Graft Kidneys were transplanted into the left iliac fossa utilizing synthetic vascular grafts in three of the 11 patients. All patients continued on their previous immunosuppression regime with a perioperative increase in intravenous corticosteroids. All kidneys functioned immediately and have normal renal function at follow-up (six mo. to 15 yrs). No deterioration in pancreatic function was noted at follow-up

Patient, Kidney and Pancreas Survival % (years)

Years Post SPK	1	5	10	15
Patient	96.5%	91.5%	71.8%	48.5&
Kidney	95.7%	85.4%	54.3%	34.2%
Pancreas	81.4%	73.1%	54.5%	40.7%

.

Conclusions:Renal retransplantation is an effective treatment option in SPK patients who lose their first kidneys. The procedure can be accomplished successfully with excellent outcomes and without risk to the pancreatic graft.

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