Results of Second Renal Transplantation in Pediatric Patients
In order to assess the factors that influence the prognosis of pediatric kidney retransplantation, we studied the outcome of 119 second transplantations performed in our pediatric transplantation unit. Between 1972 and 1995, 819 first grafts and 119 second grafts were performed in 716 adolescents and children. The 119 retransplant recipients were 3 years 9 months to 22 years old at the time of the second graft. One hundred and three patients received a cadaveric kidney (CK) and 16 a kidney from a living related donor (LRD). For the analysis of the outcome, we divided the patients into 3 groups according to the cause of first graft loss: 39 patients had had a non-immunological first graft loss (vascular thrombosis, urological problems, non-viable kidney), (group I). In 78 patients graft loss was due to rejection: within the first year in 31 patients (group II) and after 1 year in 47 patients (group III). Two patients were excluded because of uncertain etiology of graft loss. The percentage of patients with cytotoxic antibodies was 59% in group I (mean level 24%), 81% in group II (mean level 42%) and 53% in group III (mean level 19%). As a rule, no more than 2 HLA mismatches were accepted for the second graft when the first graft had been lost from rejection. The mean number of class I and class II mismatches were respectively 1.92 and 0.63 in group I, 1.26 and 0.71 in group II, 1.56 and 0.49 in group III. The immunosuppressive treatment was not different from that of first graft: conventional (prednisone + azathioprine) in 22 patients up to September 1984, thereafter associated induction therapy (antilymphocyte globulin in 65 patients and OKT3 in 22 patients) and cyclosporin from day 6 in all patients. Three patients received tacrolimus as rescue therapy.