Korean J Intern Med.  2015 Sep;30(5):657-664. 10.3904/kjim.2015.30.5.657.

Immunologic and non-immunologic complications of a third kidney transplantation

• Kim HS
• Kim JY
• Kang EJ
• Choi YS
• Kim JI
• Moon IS
• Choi BS
• Park CW
• Yang CW
• Kim YS
• Chung BH

• KMID: 2381564
• DOI: http://doi.org/10.3904/kjim.2015.30.5.657

Abstract

BACKGROUND/AIMS
Patients who undergo repeat kidney transplantations (KTs) are considered at high risk for experiencing immunologic and non-immunologic complications. In this study, we investigated the clinical outcomes, including medical and surgical complications, of patients who underwent a third KT at our center.
METHODS
Between March 1969 and December 2012, a total of 2,110 KTs were performed at the Seoul St. Mary's Hospital. Of them, we examined 11 patients who underwent a third KT, and investigated the allograft outcomes and complication rates.
RESULTS
The mean follow-up duration after KT was 72.4 ± 78.3 months. The mean age at KT was 38.2 ± 8.0 years, and seven patients (63.6%) were males. Nine patients (81.8%) underwent living-donor KT. A cross-match test yielded positive results in four of the nine patients, and all underwent pretransplant desensitization therapy. After KT, three patients (27.2%) showed delayed graft function. Acute rejection developed in four patients (36.4%), and surgical complications that required surgical correction occurred in three patients. Allograft failure developed due to acute rejection (n = 3) or chronic rejection (n = 1) in four patients. Allograft survival rates at 1, 5, and 10 years were 81.8%, 42.9%, and 42.9%, respectively; however, the allograft survival rate at 5 years was > 80% in patients who underwent KT only after results of the panel reactive antibody test became available.
CONCLUSIONS
Thus, a third KT procedure may be acceptable, although aggressive pretransplant immune monitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications.

Keyword

Kidney transplantation; Retransplantation; Complication; Allograft survival

MeSH Terms

Acute Disease
Adult
Allografts
Chronic Disease
Delayed Graft Function/diagnosis/*etiology/therapy
Female
Graft Rejection/diagnosis/*immunology/therapy
Graft Survival
*Histocompatibility
Humans
Immunosuppressive Agents/therapeutic use
Kidney Transplantation/*adverse effects
Male
Middle Aged
Patient Selection
Reoperation
Republic of Korea
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Immunosuppressive Agents