Department of General and Visceral Surgery, University of Muenster, Germany.
Transpl Int. 2011 Mar;24(3):284-91. doi: 10.1111/j.1432-2277.2010.01197.x. Epub 2010 Dec 13.
The management of an asymptomatic failed renal graft remains controversial. The aim of our study was to explore the effect of failed allograft nephrectomy on kidney retransplantation by comparing the outcome of recipients who underwent graft nephrectomy prior to retransplantation with those who did not. Retrospective comparison of patients undergoing kidney retransplantation with (group A, n = 121) and without (group B, n = 45) preliminary nephrectomy was performed, including subgroup analysis with reference to patients with multiple (≥2) retransplantations and patients of the European Senior Program (ESP). Nephrectomy leads to increased panel reactive antibody (PRA) levels prior to retransplantation and is associated with significantly increased rates of primary nonfunction (PNF; P = 0.05) and acute rejection (P = 0.04). Overall graft survival after retransplantation was significantly worse in group A compared with group B (P = 0.03). Among the subgroups especially ESP patients showed a shorter graft survival after previous allograft nephrectomy. On the multivariate analysis, pretransplant graft nephrectomy and PRA >70% were independent and significant risk factors associated with graft loss after kidney retransplantation. Nephrectomy of the failed allograft was not beneficial for retransplant outcome in our series. Patients with failed graft nephrectomy tended to have a higher risk of PNF and acute rejection after retransplantation. The possibility that the graft nephrectomy has a negative impact on graft function and survival after retransplantation is worth studying further.
无症状性移植肾失功的处理仍存在争议。本研究旨在通过比较移植肾切除术前和术后再次移植患者的结局，探讨移植肾切除对再次移植的影响。我们对行再次移植的患者进行回顾性比较，其中行移植肾切除（A 组，n = 121）和未行移植肾切除（B 组，n = 45），并进行了包括多次（≥2 次）再移植和欧洲老年人计划（ESP）患者的亚组分析。移植肾切除会导致再次移植前的群体反应性抗体（PRA）水平升高，并与原发性无功能（PNF；P = 0.05）和急性排斥反应（P = 0.04）的发生率显著增加相关。与 B 组相比，A 组患者再次移植后的移植肾存活率显著降低（P = 0.03）。在亚组中，尤其是 ESP 患者，在先前的同种异体移植肾切除术后，移植肾的存活率更短。多变量分析显示，移植前移植肾切除和 PRA＞70%是与再次移植后移植物丢失相关的独立且显著的危险因素。在我们的系列研究中，同种异体移植肾切除对再次移植结局无益。行移植肾切除的患者在再次移植后发生 PNF 和急性排斥反应的风险较高。移植肾切除对再次移植后移植物功能和存活产生负面影响的可能性值得进一步研究。
