|Home | About | Journals | Submit | Contact Us | Français|
Background. Renal re-transplants are increasing in number, due to many first renal transplant patients coming back to dialysis treatment. There are controversial opinions about the evolution of these re-transplanted patients. The aim of our study is to analyse the prognosis of patients and grafts under a renal re-transplant.
Methods. This was a retrospective study of 579 renal re-transplants realized in 15 Spanish different centres in the years 1990, 1994, 1998 and 2002 including all renal re-transplants realized in the above-mentioned centres during the same periods.
Results. During the follow-up period, 8.81% of patients died. The actuarial patient survival was 85% at 10 years and 80% at 15 years. Principal reasons of death were the same as normal for the renal transplanted patient: cardiovascular (30.77%), infectious (13.46%) and neoplastic (13.46%). During the period of follow-up, 28.6% of the grafts were lost. The actuarial graft survival was 75% at 10 years and 58% at 15 years. Causes of graft loss are very similar to those described in literature.
Conclusion. Renal re-transplant is a kind of substitute renal treatment with excellent clinical results that allow to take it as a first-order modality of treatment when the first renal transplant has failed.
Renal re-transplant is a situation in which a worse result is expected compared to the first transplant, due to diverse factors among which it would be necessary to mention the possibility of more anti-human leucocyte antigen (HLA) antibodies existing in the recipient to possible donors, a worse general condition from the cardiovascular point of view, the advanced age of both donor and recipient, etc. The aim of this work is to review the renal re-transplants done in Spain in the period 1990–2002, specifically in the years 1990, 1994, 1998 and 2002, in order to be able to determine if patient and graft survival are good as well as to realize a description of their evolution.
The sample was formed of 579 renal re-transplants realized in 15 Spanish different centres in the years 1990, 1994, 1998 and 2002. This retrospective study included all the renal re-transplants realized in the above-mentioned centres during those periods. Their stratification per year was as follows: 1990 (13.13%), 1994 (22.63%), 1998 (38.75%) and 2002 (28.50%). Nevertheless, the differences in percentage do not equate to an increase of the proportion of re-transplants, since when we analyse the percentage that the re-transplants represent with regard to the number of the first realized transplants every year, the proportions are very similar: 1990 (9.2%), 1994 (12.2%), 1998 (13.9%) and 2002 (12.4%). The mean age of the donors was 40.31 ± 16 years (12–77) and that of the recipients 41.86 ± 12 years (19–75), the mean weight of the recipients being 63.19 ± 12.13 kg. As for gender, the donors were men in 66.49% (women 33.51%), and the recipients were men in 59.07% (women 40.93%) (Table 1).
The mean of the quantitative variables during the first year has been calculated with the values obtained at the time of transplant, Month 1, Month 3 and Year 1 post-transplant. The curves of survival have been obtained by the Kaplan–Meier method.
Previous results take us to the conclusion that the results of renal re-transplant in Spain are excellent, showing patient and graft survivals at 10 years of 85% and 75%, respectively, similar to those undergoing a first transplant, and even better than described in general series of other countries . Some authors have recently described that, in patients with standard immunological risk  and even in groups of high risk such as the Afro-American population , renal re-transplant gives identical results to the first transplant. Some authors obtain the same conclusions regarding the good evolution of renal re-transplants and recommend it unreservedly (10). In our data, renal function was kept stable throughout the time period, and the reasons of graft loss would be the same as those of the general series of the first transplants . The percentage of acute tubular necrosis (39.25%) is superior to the current one when the donor and recipient mean ages are about 40 years old, and there is also a higher percentage of acute rejection than the current one, though it is easily understandable as a consequence of the current immunosuppressive medication. It is necessary to emphasize that 51% of these re-transplants have been under biopsy throughout an important period of follow-up. The most common find of the biopsy will be the non-specific fibrosis and tubular atrophy.
It is necessary to conclude that renal re-transplant is a kind of substitute renal treatment with excellent clinical results that allow to take it as a first-order modality of treatment when the first renal transplant has failed.
Conflict of interest statement. None declared.