Department of Urology and Transplantation, University Hospital of Amiens, Amiens, France.
Int Urol Nephrol. 2013 Feb;45(1):87-92. doi: 10.1007/s11255-012-0369-8. Epub 2013 Jan 18.
To determine the impact of non-functional renal graft nephrectomy on second kidney transplantation survival.
We performed a retrospective study on patients managed in our department from April 1989 to April 2011. We compared the number of acute graft rejections and graft survival between patients undergoing second transplantation with (Group I) or without (Group II) prior graft nephrectomy.
A total of ninety-one patients received a second renal graft: 43 underwent graft nephrectomy and 48 kept their non-functional renal graft. There were 5 episodes of acute graft rejection in Group I and 12 in Group II (p = 0.3). Six (13.9 %) grafts failed in Group I and eight (16.6 %) in Group II. Five and 10 years actuarial graft survival in Group I were, respectively, 91 and 85 %, while in Group II were 82.7 % and 69 % (p = 0.2). PRA level and number of acute rejection episodes did not have a statistically significant influence on graft survival, whether the patient had a nephrectomy or not (p = 0.2).
Nephrectomy of a failed allograft did not significantly improve the survival of a subsequent graft. Graft nephrectomy should be indicated in case of graft-related pain or a chronic inflammation syndrome.
确定非功能性移植肾切除对再次肾移植存活的影响。
我们对 1989 年 4 月至 2011 年 4 月在我院接受治疗的患者进行了回顾性研究。我们比较了行第二次移植的患者中，伴有（组 I）或不伴有（组 II）先前移植肾切除的急性排斥反应的次数和移植物存活率。
共 91 例患者接受了第二次肾移植：43 例行移植肾切除术，48 例保留了非功能性移植肾。组 I 中有 5 例急性移植物排斥反应，组 II 中有 12 例（p = 0.3）。组 I 中有 6 个（13.9%）移植物失败，组 II 中有 8 个（16.6%）。组 I 的 5 年和 10 年移植物存活率分别为 91%和 85%，而组 II 分别为 82.7%和 69%（p = 0.2）。无论是否行肾切除术，PRA 水平和急性排斥反应次数对移植物存活率均无统计学显著影响（p = 0.2）。
移植肾失功后行肾切除术并不能显著提高随后移植肾的存活率。只有在与移植物相关的疼痛或慢性炎症综合征的情况下，才应考虑进行移植肾切除术。
