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Retransplantation: Challenges and Strategies

  • Stephen P. Dunn
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

Retransplantation has become standard therapy for children who are solid organ transplant recipients of a failed prior transplant. The experience of these children is quite similar across all solid organs transplanted. Children who receive a second transplant have outcomes of the transplant that are not as good as the first transplant with lower early and late graft survival rates. Mortality rates are higher and other morbidities or complications more common. Long-term causes of transplant organ failure are many. One of the most significant is chronic rejection but it is not the only factor that is relevant. The best outcomes for children are the result of multiple factors. These include initial organ selection with living donors having the best long-term outcome. Those who have transplants with fewer surgical complications and have initial good organ function have improved graft survival. Careful management of antibody incompatibilities is also important. Highly effective immunosuppressive agent management and careful graft and recipient diagnostic testing and intervention add long-term benefit. Careful recipient follow-up and medical care improve long-term patient and graft survival. Improving the first transplant outcome is the best solution to the problem of retransplantation.

Keywords

Retransplantation Chronic rejection Antibody-mediated rejection Surgical complications 

References

  1. Axelrod DA, McCullough KP, Brewer ED et al (2010) Kidney and pancreas transplantation in the United States, 1999–8: the changing face of living donation. Am J Transplant 10:987CrossRefPubMedGoogle Scholar
  2. Chen A, Martz K, Kershaw D et al (2010) Mortality risk in children after renal allograft failure: a NAPRTCS study. Pediatr Nephrol 25:2517–2522CrossRefPubMedGoogle Scholar
  3. Davis A, Rosenthal P, Glidden D (2009) Pediatric liver retransplantation: outcomes and a prognostic scoring tool. Liver Transpl 15:199–207Google Scholar
  4. Meier-Kriesche H, Schold JD, Srinivas TR et al (2004) Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant 4:378–383CrossRefPubMedGoogle Scholar
  5. Minson S, Munoz M, Vergara I et al (2013) Nephrectomy for the failed renal allograft in children: predictors and outcomes. Pediatr Nephrol 28:1299–1305CrossRefPubMedGoogle Scholar
  6. Ng V, Anand R, Martz K et al (2008) Liver retransplantation in children: a SPLIT database analysis of outcome and predictive factors for survival. Am J Transplant 8:386–395Google Scholar
  7. Potter DE, Najarian J, Belzer F et al (1991) Long-term results of renal transplantation in children. Kidney Int 40:752–756CrossRefPubMedGoogle Scholar
  8. Rao PS, Ojo A. (2008) Organ retransplantation in the United States: trends and implications. Clin Transpl 57–67Google Scholar
  9. Van Arendonk KJ, Garonzik-Wang JM, Deshpande NA et al (2013) Practice patterns and outcomes in retransplantation among pediatric kidney transplant recipients. Transplantation 95:1360–1368CrossRefPubMedPubMedCentralGoogle Scholar
  10. Van Arendonk KJ, Chow EKJ, James NT et al (2015) Choosing the order of deceased donor and living donor kidney transplantation in pediatric recipients: a Markov decision process model. Transplantation 99:360–366CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryJefferson Medical CollegeWilmingtonUSA

Section editors and affiliations

  • Deborah M Consolini
    • 1
  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

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