Retrospective Study
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World J Transplant. Jun 24, 2014; 4(2): 141-147
Published online Jun 24, 2014. doi: 10.5500/wjt.v4.i2.141
Impact of transplant nephrectomy on peak PRA levels and outcome after kidney re-transplantation
Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Gerd Offermann, Marcel Geyer, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz
Dietlind Tittelbach-Helmrich, Przemyslaw Pisarski, Oliver Thomusch, Ulrich Theodor Hopt, Oliver Drognitz, Department of General Surgery, University of Freiburg, 79106 Freiburg i. Brsg., Germany
Dietlind Tittelbach-Helmrich, Department of General Surgery, University of Luebeck, 23538 Luebeck, Germany
Gerd Offermann, Transplant Center, Medical Department IV, Campus Benjamin Franklin, University Charité of Berlin, 12200 Berlin, Germany
Marcel Geyer, Department of Nephrology, University of Freiburg, 79106 Freiburg i. Brsg., Germany
Author contributions: Drognitz O designed the study; Gerd Offermann G and Tittelbach-Helmrich D collected and analyzed the data and wrote the paper; Geyer M and Thomusch O were involved in interpretation of data and editing the manuscript; Pisarski P and Hopt UT were involved in the design of the study and revised the paper critically.
Correspondence to: Dr. Dietlind Tittelbach-Helmrich, Department of General Surgery, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. dietlind.tittelbach-helmrich@uksh.de
Telephone: +49-451-5002001 Fax: +49-451-5002069
Received: November 27, 2013
Revised: April 16, 2014
Accepted: May 16, 2014
Published online: June 24, 2014
Processing time: 235 Days and 3.5 Hours
Abstract

AIM: To determine the impact of transplant nephrectomy on peak panel reactive antibody (PRA) levels, patient and graft survival in kidney re-transplants.

METHODS: From 1969 to 2006, a total of 609 kidney re-transplantations were performed at the University of Freiburg and the Campus Benjamin Franklin of the University of Berlin. Patients with PRA levels above (5%) before first kidney transplantation were excluded from further analysis (n = 304). Patients with graft nephrectomy (n = 245, NE+) were retrospectively compared to 60 kidney re-transplants without prior graft nephrectomy (NE-).

RESULTS: Peak PRA levels between the first and the second transplantation were higher in patients undergoing graft nephrectomy (P = 0.098), whereas the last PRA levels before the second kidney transplantation did not differ between the groups. Age adjusted survival for the second kidney graft, censored for death with functioning graft, were comparable in both groups. Waiting time between first and second transplantation did not influence the graft survival significantly in the group that underwent nephrectomy. In contrast, patients without nephrectomy experienced better graft survival rates when re-transplantation was performed within one year after graft loss (P = 0.033). Age adjusted patient survival rates at 1 and 5 years were 94.1% and 86.3% vs 83.1% and 75.4% group NE+ and NE-, respectively (P < 0.01).

CONCLUSION: Transplant nephrectomy leads to a temporary increase in PRA levels that normalize before kidney re-transplantation. In patients without nephrectomy of a non-viable kidney graft timing of re-transplantation significantly influences graft survival after a second transplantation. Most importantly, transplant nephrectomy is associated with a significantly longer patient survival.

Keywords: Kidney re-transplantation; Graft nephrectomy; Panel reactive antibodies, Patient and graft survival

Core tip: In our paper, presented as “poster of distinction” at the ATC, we show that graft nephrectomy of a first non-functioning kidney graft leads to an increase in peak panel reactive antibody that normalizes before re-transplantation. In 305 low-risk patients who underwent re-transplantation, graft survival did not differ between those with or without prior nephrectomy. Interestingly, patient survival was significantly better in patients with nephrectomy. This supports the findings of Ayus et al, who investigated patients staying on maintenance dialysis after graft failure. Therefore graft nephrectomy should be considered in patients returning to dialysis after failure of a kidney transplant.