Barnes James C H, Goodyear Stephen J, Imray Caitlin E A, Lam For Tai, Kashi Habib S, Tan Lam Chin, Higgins Robert, Imray Christopher H E
Department of Transplant Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Clin Transplant. 2017 Nov;31(11). doi: 10.1111/ctr.13104. Epub 2017 Oct 5.
The demand for kidney retransplantation following graft failure is rising. Repeat transplantation is often associated with poorer outcomes due to both immunological and surgical challenges. The aim of this study was to compare surgical and functional outcomes of kidney retransplantation in recipients that had previously had at least two kidney transplants with a focus on those with antibody incompatibility.
We analyzed 66 patients who underwent renal transplantation at a single center between 2003 and 2011. Consecutive patients receiving their 3rd or 4th kidney were case-matched with an equal number of 1st and 2nd transplants.
Twenty-two 3rd and 4th kidney transplants were matched with 22 first and 22 seconds transplants. Operative times and length of stay were equivalent between the subgroups. Surgical complication rates were similar in all groups (22.7% in 1st and 2nd transplants, and 27.2% in 3rd/4th transplants). There was no significant difference in patient or graft survival over 5 years. Graft function was similar between transplant groups at 1, 3, and 5 years.
Third and fourth kidney transplants can be performed safely with similar outcomes to 1st and 2nd transplants. Kidney retransplantation from antibody-incompatible donors may be appropriate for highly sensitized patients.
移植肾失功后再次肾移植的需求正在增加。由于免疫和手术方面的挑战，再次移植往往与较差的预后相关。本研究的目的是比较既往至少接受过两次肾移植的受者再次肾移植的手术和功能结局，重点关注抗体不相容的受者。
我们分析了2003年至2011年在单一中心接受肾移植的66例患者。接受第3次或第4次肾移植的连续患者与相同数量的第1次和第2次移植患者进行病例匹配。
22例第3次和第4次肾移植与22例第1次和22例第2次移植相匹配。各亚组之间的手术时间和住院时间相当。所有组的手术并发症发生率相似（第1次和第2次移植为22.7%，第3次/第4次移植为27.2%）。5年的患者或移植物存活率无显著差异。移植组在1年、3年和5年时的移植物功能相似。
第3次和第4次肾移植可以安全进行，其结局与第1次和第2次移植相似。来自抗体不相容供体的再次肾移植可能适用于高度致敏患者。
