TOPLINE:

Deceased donor kidney transplant as a retransplant (either second or third transplantation) showed relatively favorable outcomes with low graft rejection and failure rates among patients with prior graft failure.

METHODOLOGY:

• Patients with failed primary kidney grafts face immunologic sensitization and surgical complexities that make retransplant challenging. Due to a shortage of donor kidneys, deceased donor transplants may be crucial for those with failed primary grafts.
• Researchers conducted a retrospective analysis to assess graft and patient outcomes in 21 patients (mean age, 41 years; 38.1% male) who underwent deceased donor kidney transplant as a retransplant (either second or third) using kidneys from 21 donors (mean age, 37.48 years; 85.7% male) at a tertiary care center in Saudi Arabia between June 2014 and December 2023.
• Patients were followed up for 12-126 months. Data collected included demographic and clinical information, intraoperative details, and information on immunosuppressive regimens (such as thymoglobulin, mycophenolate mofetil, tacrolimus, and methylprednisolone).
• Outcomes such as graft rejection, failure, and mortality were analyzed using the collected clinical data.
• Graft loss was defined as retransplant, dialysis, or death while still having a functional graft; graft rejection was defined as histologically clear rejection on the basis of specific criteria confirmed by a biopsy of the transplant kidney using ultrasound guidance.

TAKEAWAY:

• The mean cold ischemia time was 12.90 hours, and the mean anastomosis time was 43.76 minutes. Intraoperative hypotension was observed in 42.9% of cases, with 19.0% requiring hemodialysis within 7 days post-operation.
• Graft rejection occurred in 14.3% of patients, and graft loss was noted in 9.5%. The mean serum creatinine level at the final follow-up was 103.81 μmol/L.
• No significant association was found between the modality of renal replacement therapy and graft loss or graft rejection.
• Mortality occurred in two patients (9.5%). The modality of renal replacement therapy showed no significant link with mortality, but a longer mean duration of therapy was observed in deceased vs surviving patients, which was not statistically significant.

IN PRACTICE:

“Our study provides encouraging evidence supporting the use of deceased donor kidney transplantation as a second or third transplant in patients with prior graft failure. With meticulous perioperative management and standardized immunosuppression, favorable patient and graft survival can be achieved, even in this high-risk group. Our findings support the expansion of DDKT [deceased donor kidney transplant] programs to address the donor organ gap and offer renewed hope to patients who have exhausted primary transplantation options,” the authors of the study wrote.

SOURCE:

The study was led by Bilal Mohsin, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. It was published online in the Open Journal of Nephrology.

LIMITATIONS:

The small sample size limited the statistical power to detect significant associations. The lack of protocol biopsies, due to issues with patient consent, may have led to underdiagnosis of subclinical graft rejection. The retrospective design may introduce selection bias and affect data accuracy. As a single-center study, the findings may not be generalizable to diverse populations with different immunosuppressive practices.

DISCLOSURES:

The study did not report any specific funding. The authors reported having no potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.