Retransplantation of HLA Identical Sibling’s Kidney in One Patient: The ‘Royal’ Way for a Happy Few
M.B.Z. presented a chronic renal failure (CRF) secondary to a familial tubulo-interstitial nephritis. Immunological screening of the five other siblings of the family showed two of them with complete HLA A2, A24; B7, B62; DR 14, DR15; Dq5, Dd6 identity. No renal abnormalities were found in these two potential donors. The first transplantation was performed with a sister’s kidney on November 19 1979. Outcome was excellent but local infection of the wound, followed by CMV infection led to a 3 month stay in the nephrology department. Progressively, the patient completely recovered and worked full time. Seven years later the patient spontaneously stopped his immunosuppressive drugs (imuran 100 mg/day, prednisolone 15 mg alternate days) without refering to the staff: one reason could be the normal health feeling and the absence of any problem during these seven years. Eight months later, after a dental infection episode, acute rejection occured with only partial response to methylprednisolone pulse therapy and addition of cyclosporin A. The transplant biopsy showed chronic cellular rejection with major interstitial fibrohyalinosis. 17 years after this first graft, terminal renal failure was present. The decision was taken to perform a second kidney graft from his HLA identical brother. The retransplantation was performed on November 13 1996, with no dialysis and the first graft still present. A uretero-ureteral anastomosis was performed because of the short ureta from his living donor. Outcome was excellent and within 10 days the patient was back home. This observation underlines the feasability of retransplantion from identical siblings. This allows dialysis prior to the second graft to be avoided.