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Do re-grafts require more aggressive immunosuppression?

  • Amanda J. Robertson
  • Peter J. Morris
Part of the Transplantation and Clinical Immunology book series (TRAC, volume 29)

Abstract

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 [1] although Registry data has shown that regrafts do not do so well [2, 3], with regraft survival up to 10% lower than first grafts [4]. 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. [7] 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 [8]. The reasons for this are multifactorial, but include high sensitization and associated positive crossmatches, and a presumption of worse outcome for regrafts [9]. 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.

Keywords

Acute Rejection Graft Survival Triple Therapy Graft Loss Chronic Lymphatic Leukaemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Morris PJ. Results of renal transplantation. In: Morris PJ (ed.), Kidney Transplantation Principles and Practice. W.B. Saunders, 1994.Google Scholar
  2. 2.
    Opelz G. Collaborative Transplant Study — 10th Anniversary, 1993, p. 1.Google Scholar
  3. 3.
    Terasaki PI, Cecka JM, Gjertson DW, Cho Y, Takemoto S, Cohn M. A ten-year prediction for kidney transplant survival. In: Terasaki PI, Cecka JM (eds.), Clinical Transplants. U.C.L.A. Tissue Typing Laboratory, Los Angeles, 1992, p. 501.Google Scholar
  4. 4.
    Ogura K, Cecka JM. Cadaver retransplants. Clin. Transplant. 1990; 471–483.Google Scholar
  5. 5.
    Hiesse C, Neyrat N, Busson M, Bensadoun H, Lantz O et al. High rate of success in kidney cadaveric retransplantation with optimal matching and potent immunosuppression. Transplant. Proc. 1990; 22: 1909–1910.PubMedGoogle Scholar
  6. 6.
    Fasola CG, Fryd DS, Fischel RJ, Ascher NL, Payne WD et al. Adult kidney retransplantation: evolution of treatment and results over 25 years at the University of Minnesota. Transplant. Proc. 1989; 21: 2165–2167.PubMedGoogle Scholar
  7. 7.
    Hirata M, Terasaki PI. Renal retransplantation. Clin. Transplant. 1994; 419–433.Google Scholar
  8. 8.
    UNOS. 1993 Annual report of the U.S. Scientific Registry of Transplant recipients and the organ procurement and transplantation network. Richmond, VA: UNOS, and Bethesda, MD: Division of Organ Transplantation, Health Resources and Services Administration.Google Scholar
  9. 9.
    Mahoney RJ, Norman DJ, Colombe BW, Garovoy MR, Leeber DA. Identification of high and low risk second kidney grafts. Transplantation 1996; 61: 1349–1355.PubMedCrossRefGoogle Scholar
  10. 10.
    Taylor C, Welsh K et al. Clinical and socioeconomic benefits of serological HLA-DR matching for renal transplantation over three eras of immunosuppression regimens in a single unit. In: Terasaki PI (ed.), Clinical Transplants 1993; U.C.L.A. Tissue Typing Laboratory, Los Angeles.Google Scholar
  11. 11.
    UK National Transplant Database: a digest of published audit material. UKTSSA National Transplant Database. Clin. Transplant. 1995; 91–110.Google Scholar
  12. 12.
    Mitsuishi Y, Cecka JM. Recent improvements in cadaver-donor kidney retransplantation. Clin. Transplant. 1991; 281–291.Google Scholar
  13. 13.
    Evans RW, Manninen DL, Dong FB, McLynne DA. Is retransplantation cost effective? Transplant. Proc. 1993; 25: 1694–1696.PubMedGoogle Scholar
  14. 14.
    Ogura K. Sensitisation. In: Terasaki PI, Cecka JM (eds.), Clinical Transplants 1992. U.C.L.A. Tissue Typing Laboratory, Los Angeles, 1993, p. 357.Google Scholar
  15. 15.
    Kountz SL, Thibault PM, Endo T, Margules R, Balzer O. Results of immediate and delayed retransplantation. Transplant. Proc. 1972; 4: 739.Google Scholar
  16. 16.
    Husberg BS, Starzl TE. The outcome of kidney transplantation. Arch. Surg. 1974; 108: 584.PubMedGoogle Scholar
  17. 17.
    Opelz G, Gustafsson LA, Terasaki PI. Influence of interval between first graft removal and retransplantation on outcome of second cadaver kidney grafts. Transplantation 1976; 22: 521.PubMedCrossRefGoogle Scholar
  18. 18.
    Ascher NL, Ahrendolz DH, Simmons RL, Najarian JS. 100 second renal allografts from a single transplantation institution. Transplantation 1979; 27: 30.PubMedCrossRefGoogle Scholar
  19. 19.
    Abouljoud MS, Deierhoi MH, Hudson SL, Diethelm AG. Risk factors affecting second renal transplant outcome, with special reference to primary allograft nephrectomy. Transplantation 1995; 60: 138–144.PubMedGoogle Scholar
  20. 20.
    Schweizer RT, Bow L, Roper L, Hull D, Bartus SA. Renal transplantation at Hartford Hospital. Connecticut. Clin. Transplant. 1988; 147–158.Google Scholar
  21. 21.
    Gaber AO, Thistlewaite JR, Haag BW, Stuart J, Mayes J et al. Transplant. Proc. 1987; 19: 1915–1916.PubMedGoogle Scholar
  22. 22.
    Peraldi MN, Akposso K, Haymann JP, Flahaut A, Marlin C et al. Long-term benefit of intravenous immunoglobulins in cadaveric kidney retransplantation. Transplantation 1996; 62: 1670–1673.PubMedCrossRefGoogle Scholar
  23. 23.
    Tejani A, Sullivan EK. Factors that impact on the outcome of second renal transplants in children. Transplantation 1996; 62: 606–611.PubMedCrossRefGoogle Scholar
  24. 24.
    Gaston RS, Shroyer TW, Hudson SL, Deierhoi MH, Laskow DA et al. Renal retransplantation: the role of race, quadruple immunosuppression, and the flow cytometry cross-match. Transplantation 1994; 57: 47–54.PubMedCrossRefGoogle Scholar
  25. 25.
    Shapiro R, Jordan ML, Scantlebury VP, Vivas C, Fung JJ et al. A prospective randomised trial of FK506-based immunosuppression after renal transplantation. Transplantation 1995; 59: 485–490.PubMedGoogle Scholar
  26. 26.
    Sanfililppo F, Goeken N, Niblack G, Scornik J, Vaughn WK. The effect of first cadaver renal transplant HLA-A, B match on sensitization levels and retransplant rates following graft failure. Transplantation 1987; 43: 240–243.CrossRefGoogle Scholar
  27. 27.
    Welsh KI, van Dam M, Bewick ME, Koffman GK, Taube DH et al. Successful transplantation of kidneys bearing previously HLA A and B locus antigens. Transplant. Int. 1988; 1(4): 190–195.CrossRefGoogle Scholar
  28. 28.
    Povlsen JV, Madsen M, Birkeland SA, Lokkegaard H, Pedersen EB et al. The impact of repeated HLA mismatches on the outcome of renal allograft retransplantation. Transplant. Proc. 1992; 24: 307–308.PubMedGoogle Scholar
  29. 29.
    Cecka JM, Terasaki PI. Repeating HLA antigen mismatches in renal retransplants — a second class mistake? Transplantation 1994; 57: 515–519.PubMedCrossRefGoogle Scholar
  30. 30.
    Hendriks GF, de Lange P, Persijn GG and van Rood JJ. Cyclosporine A, hyperimmunized patients and renal retransplantation. Transplant. Proc. 1987; 19: 733–734.PubMedGoogle Scholar
  31. 31.
    Stratta RJ, Oh C-S, Sollonger HW, Pirsch JD, Kalayoglu M et al. Kidney retransplantation in the cyclosporine era. Transplantation 1988; 45: 40–45.PubMedCrossRefGoogle Scholar
  32. 32.
    Almond PS, Matas AJ, Gillingham K, Troppmann C, Payne W et al. Risk factors for second renal allografts immunosuppressed with cyclosporine. Transplantation 1991; 52: 253–258.PubMedCrossRefGoogle Scholar
  33. 33.
    Imagawa DK, Cecka JM. Renal regrafts. Clin. Transplant. 1988; 387–398.Google Scholar
  34. 34.
    Fasola CG, Kim YS, Morel P, Dunn DL, Sutherland DER et al. Kidney retransplantation: patients with a failed second kidney transplant should be considered for a third transplant. Transplant. Proc. 1991; 23: 1336.PubMedGoogle Scholar
  35. 35.
    Douzdjian V, Rice JC, Carson RW, Gugliuzza KK, Fish JC. Renal retransplants: effect of primary allograft nephrectomy on early function, acute rejection and outcome. Clin. Transplant. 1996; 10: 203–208.PubMedGoogle Scholar
  36. 36.
    Sumrani N, Delaney V, Hong JH, Daskalakis P, Sommer BG. The influence of nephractomy of the primary allograft on retransplant graft outcome in the cyclosporine era. Transplantation 1992; 53: 52–55.PubMedCrossRefGoogle Scholar
  37. 37.
    Freier DT, Haines RF, Rosenzweig J, Niederhuber J, Konnak J et al. Sequential renal transplants: some surgical and immunological implications on management of the first homograft. Surgery 1976; 79: 262.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Amanda J. Robertson
  • Peter J. Morris

There are no affiliations available

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