Results of kidney retrasplantation: a review of 90 cases from a single center.

The purpose of this study is to report a 23-year experience on second kidney transplantations. Of the 1266 kidney transplants performed in our Department between 1983 and 2006, 90 were second grafts. Kidney retransplantation was performed in 69 men and 21 women (patient’s mean age: 36.8 +/- 13.5 years). Cadaver donor grafts were transplanted in 84 patients, whereas the remaining 6 patients were retransplanted from livingrelated donors (6.6%). Nineteen recipients (21%) were sensitized with a panel reactive antibody (PRA) =>50% (range 50-80%) because of the presence of anti-HLA antibodies direct against class I and/or class II specificities. Sixty-five of second graft recipients (72%) had no more than two total mismatches (HLA-A, B, DR) according to the high HLA matching policy, including also the avoiding of repeated HLA mismatches carried out for retransplanted recipients. Patients with a posttransplant follow-up less than 12 months were excluded from analysis. Actuarial patient and graft survival curves were estimated by using Kaplan-Meier method. At 1, 5 and 10 years patient survival rates were 100%, 96%, and 90%, respectively, whereas graft survival rates were 89%, 74% and 45%. Causes for the observed 16 graft losses were: (a) chronic rejection in 8 cases (50%); (b) accelerated vascular rejection in one case (6.2%); (c) death with a functioning second graft in 4 patients (25%); (d) vascular thrombosis in two patients (12.5%); (e) surgical complications in one patient (6.2%). Although second graft recipients have a wide range of risk factors such as high PRA, surgical complications, and increased percentage of acute rejection episodes, our results suggest that second graft and patient survival rates could still be satisfactory and statistically not different from that of a first graft recipients, provided a good HLA matching policy.