Introduction:

This study aims to review the impact of nephrectomy of a failed primary allograft on the graft survival of renal retransplantation.

Material/Method:

This is a retrospective study of all the failed renal allograft patients who received a second kidney transplant in our institution from 2000 until October 2011. There were 94 recipients in total. The patients were split into two groups, those that had a primary allograft nephrectomy prior to their retransplantation (G1, n: 46) and those who did not (G2, n: 48), including a subgroup analysis of patients that received multiple retransplantations. The data was obtained from a computerized and validated database called Filemaker Pro 5.5 and from the institution Clinical Transplantation Laboratory. Data was collected and added to this database prospectively and the variables looked at this study were gathered from the database retrospectively. In all patients of G1 the graft was removed for clinical indications. The two groups were retrospectively compared in terms of graft survival, failed second allograft nephrectomy, acute rejection rate and Panel Reactive Antigen (PRA) levels.

Summary of results:

One year graft survival in the nephrectomy group was 84.8% % as compared to 100% in the control group.

18 patients received multiple (more than 2) renal allografts, 12 (66.6%) of them belonging to the primary graft nephrectomy group. 5 patients with a failed second transplant had to be nephrectomised for second time, all of them belonging to the primary nephrectomy group (G1).

There was no statistically significant difference in the acute rejection rate among the two groups. Namely, it was 17.4% in G1 as compared to 18.8% in the control group.

The PRA levels rose significantly after the first transplant but there was no significant difference in the PRA levels among the nephrectomy and the control group.

Conclusions:

Graft nephrectomy has a negative impact on the life of the second transplanted allograft. The acute rejection rates in renal retransplantation are not affected by the removal of the failed allograft and there was no statistical evidence that the PRA varied significantly post nephrectomy of the failed graft. Finally, the allograft recipients undergoing first graft nephrectomy are in increased relative risk of requiring second graft nephrectomy should the second allograft fails.

The effect of graft nephrectomy on the graft survival and recipient sensitization after retransplantation is worth being investigated further.

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