Retransplantation: Challenges and Strategies
Retransplantation has become standard therapy for children who are solid organ transplant recipients of a failed prior transplant. The experience of these children is quite similar across all solid organs transplanted. Children who receive a second transplant have outcomes of the transplant that are not as good as the first transplant with lower early and late graft survival rates. Mortality rates are higher and other morbidities or complications more common. Long-term causes of transplant organ failure are many. One of the most significant is chronic rejection but it is not the only factor that is relevant. The best outcomes for children are the result of multiple factors. These include initial organ selection with living donors having the best long-term outcome. Those who have transplants with fewer surgical complications and have initial good organ function have improved graft survival. Careful management of antibody incompatibilities is also important. Highly effective immunosuppressive agent management and careful graft and recipient diagnostic testing and intervention add long-term benefit. Careful recipient follow-up and medical care improve long-term patient and graft survival. Improving the first transplant outcome is the best solution to the problem of retransplantation.
KeywordsRetransplantation Chronic rejection Antibody-mediated rejection Surgical complications
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