Retransplantation following AHG-negative crossmatches

Abstract

Retransplant patients are an immunologically unique group since they have already experienced graft loss and have been exposed to a bolus of alloantigen. Having previously lost a transplant, these patients are often sensitized and have poorer early graft function resulting in patient management problems [1, 2]. Survival rates for cadaveric retransplantations have been consistently lower than those for primary grafts [3–6]. Some of the risk factors associated. with poor retransplantation outcome include patient high PRA, recipient-donor HLA mismatches, positive flow cytometry crossmatches and, perhaps the most important, previous graft survival time less than 3–6 months [3, 4, [7–9]. Since the introduction of cyclosporine based immunosuppressive protocols in 1983, the one year regraft survival rate of second cadaver donor renal allografts has remained relatively constant, whereas that of first transplants has significantly improved [9]. However, since 1988 survival rates for retransplant cadaver-donor grafts have improved each year with the difference between first and second transplant one year survival rates decreasing from 8% in 1988 to 2% in 1991 [10]. These recent improvements may reflect the impact of more efficacious immunosuppression and more sensitive and informative crossmatching [6, 11]. However, data from the UNOS Registry suggests that a decreasing number of high-risk patients, especially reTx patients with short previous graft survival times, have been retransplanted in recent years and that selection of more low-risk reTx candidates may be an important contributing factor in explaining improved regraft survivals [8].