Second Renal Allograft Transplants. Experience at a Single Institution

Abstract

Registry data of heart and liver retransplantation have revealed a pattern of patient survival that is significantly worse than results achieved by primary transplantation. To verify the trend of graft survival following renal retransplantation, we analyzed the results of 67 patients who received a second renal graft at Niguarda Hospital, Milan. Between March 1, 1984 and December 31, 1996, 67 second renal transplants (64 from cadaveric and 3 from living related donors) have been performed in 67 adult recipients (male 37) of mean age of 39 years. This series represented 8.5% of the 787 total renal transplants performed at our institution during the same period after the introduction of routine cyclosporine immunosuppression. In 51 (76.1%) of 67 patients, the cause of their primary renal graft failure was rejection (graft failure was defined by patient death or a return to dialysis). Nine of these 51 primary renal grafts were lost within 6 months of transplantation. Forty-nine (73.1%) had good function until after 5 years. The only contraindication to second transplantation was non-compliance with the medical regimen following a primary transplantation. Primary and second renal transplant patients received quadruple drug therapy (cyclosporine, azathioprine, anti-thymocyte globulin, steroids). Episodes of acute rejection were treated with methylprednisone boluses.