Same Prognosis for First and Second Kidney Transplantation: What is the Price to Pay?

Abstract

The number of patients waiting for a second graft is increasing each year due to the fear of failure imbalanced with the hope of improving new immunosuppression treatments. To ascertain the most important prognostic variables up to 5 years post transplantation, we analysed 570 patients, 512 receiving first and 58 second kidney grafts from cadaver donors, between January 1, 1986 and December 31 1995. During this period, the immunosuppression was not modified and consisted of induction with lympho-globulin. for the first grafts and thymoglobulin for the second grafts. Tritherapy was systematic for the second grafts (AZA-CsA-PRED) but AZA was stopped for the first grafts in the absence of rejection episode or delayed graft function (DGF). We applied a good matching policy in MHC class II in the second grafts (0 HLA-DR mismatch: 60% in the group of the second grafts, vs 27% in the group of first grafts, p < 0.001). Second graft patients were younger at the time of retransplantation than first graft patients (34 ± 8 years vs 39 ± 11 years, p < 0.01) but there was no other differences in pretransplant characteristics. DGF was more frequent with the second grafts (41% vs 24%, p < 0.005) but the incidence of rejection episodes and infectious complications was the same. In spite of these two bad prognostic factors (recipient’s age < 50 years and DGF), actuarial patient and graft survival rates were not different between the 2 groups.