Do re-grafts require more aggressive immunosuppression?
This study was performed to investigate whether recipients of second or subsequent renal cadaveric allografts require more intensive immunosuppression than recipients of first grafts. Oxford data demonstrates that the outcome of patients with regrafts is overall identical to those with first cadaveric grafts  although Registry data has shown that regrafts do not do so well [2, 3], with regraft survival up to 10% lower than first grafts . In most transplant centres this difference in survival between first and second grafts has decreased in the last 15 years and this has no doubt been influenced by the use of cyclosporine [5, 6]. Hirata et al.  describe a difference of as little as 1% between first and second graft survival in their patients, compatible with our own data. Kidney regraft candidates now comprise about 27% of all patients awaiting renal transplantation, but only receive 13–14% of the annual cadaveric transplants . The reasons for this are multifactorial, but include high sensitization and associated positive crossmatches, and a presumption of worse outcome for regrafts . Patients awaiting regrafting share the common experience of having lost a previous transplant and having been exposed to foreign HLA antigens. Only some of these graft losses will be the result of rejection, others having been lost to technical problems such as renal vein or artery thrombosis or to primary non-function. It is the sub-group who have mounted an immunological response sufficient to reject the primary graft that are likely to be the more difficult group in which to achieve success with a regraft, and in whom more aggressive immunosuppression might be indicated.
KeywordsAcute Rejection Graft Survival Triple Therapy Graft Loss Chronic Lymphatic Leukaemia
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