Kidney Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Kidney Transplant, including details on risks, prognosis, procedure, surgery, organ donation.

Impact of surgical procedures and complications on outcomes of third and subsequent kidney transplants.

Loupy A, Anglicheau D, Timsit MO, Thervet E, Mamzer-Bruneel MF, Martinez F, Desgranchamps F, Thiounn N, Kreis H, Legendre C, Chrétien Y, Méjean A

Service de Transplantation Rénale, Hôpital Necker, Paris, France.

BACKGROUND: Surgical procedures and complications have rarely been described in patients receiving a third or subsequent renal transplant. METHODS: Data from 61 consecutive third (n=56), fourth (n=4), and fifth (n=1) renal transplants performed during 1974 to 2005 were analyzed retrospectively. RESULTS: Actuarial graft survival was 91%, 74%, and 57% at one, five, and 10 years, respectively. Technical failure accounted for the loss of three grafts (5%). A transperitoneal approach was necessary in 41% of patients. Technical difficulties occurred in half of the procedures, mainly due to atheroma or vascular calcifications. Overall, there were 45 surgical complications in 30 patients, of urological (n=11), vascular (n=6), infectious (n=9), hemorrhagic (n=12), digestive (n=3), or wound origin (n=4). The rate of surgical revision was 16%. Univariate analysis showed that among surgical complications, only vascular complications were associated with a poor graft outcome (P=0.02). Urological complications did not influence long-term graft outcome. Multivariate analysis of all surgical procedures and complications that might have influenced graft survival showed that only vascular complications were associated with a poorer graft outcome (relative risk=6.13, P=0.015). CONCLUSIONS: Despite a high rate of surgical complications and revisions, third and subsequent kidney transplantations may be performed safely by experienced surgeons without surgical complications influencing long-term graft outcome.

Published 23 February 2007 in Transplantation, 83(4): 385-91.
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