Skip to main content

Advertisement

SpringerLink
Log in

Iterative renal transplantation: our experience on third transplants

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants.

Methods

Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants.

Results

Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%).

Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively.

Conclusion

Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rao PS, Schaubel DE, Wei G, Fenton SSA (2006) Evaluating the survival benefit of kidney retransplantation. Transplantation 82(5):669–674

    Article  Google Scholar 

  2. Redfield RR, Gupta M, Rodriguez E, Wood A, Abt PL, Levine MH (2015) Graft and patient survival outcomes of a third kidney transplant. Transplantation 99(2):416–423

    Article  CAS  Google Scholar 

  3. Ooms LSS, Roodnat JI, Dor FJMF, Tran TCK, Kimenai HJAN, Ijzermans JNM, Terkivatan T (2015) Kidney retransplantation in the ipsilateral iliac fossa: a surgical challenge. Am J Transplant 15(11):2947–2954

    Article  CAS  Google Scholar 

  4. Kienzl-Wagner K, Mark W, Maglione M, Brandacher G, Öllinger R, Margreiter R, Pratschke J, Bösmüller C (2011) Single-center experience with third and fourth kidney transplants. Transpl Int 24(8):780–786

    Article  Google Scholar 

  5. Benkö T, Halfmann P, Gäckler A, Radünz S, Treckmann JW, Kaiser GM, Hoyer DP (2019) Long-term outcome of third, fourth and fifth kidney transplantation: technical aspects and immunological challenges. Clin Kidney J 12(6):895–900

    Article  Google Scholar 

  6. Ott U, Busch M, Steiner T, Schubert J, Wolf G (2008) Renal retransplantation: a retrospective monocentric study. Transplant Proc 40(5):1345–1348

    Article  CAS  Google Scholar 

  7. Gutiérrez Baños JL, Rodrigo Calabia E, Rebollo Rodrigo M del H, Portillo Martín JA, Correas Gómez MA, Roca Edreira A, del Valle Schaan JI, Ruiz Izquierdo F, Aguilera Tubet C, Arias Rodríguez M, Martín García B. Surgical details and complications from retransplantation into the iliac fossa for third and fourth kidney transplants. Arch Esp Urol. 2005;58(2):121–9.

  8. Mazzucchi E, Danilovic A, Antonopoulos IM, Piovesan AC, Nahas WC, Lucon AM, Srougi M (2006) Surgical aspects of third and subsequent renal transplants performed by the extraperitoneal access. Transplantation 81(6):840–844

    Article  Google Scholar 

  9. Loupy A, Anglicheau D, Timsit MO, Thervet E, Mamzer-Bruneel M-F, Martinez F, Desgranchamps F, Thiounn N, Kreis H, Legendre C, Chrétien Y, Mjean A (2007) Impact of surgical procedures and complications on outcomes of third and subsequent kidney transplants. Transplantation 83(4):385–391

    Article  Google Scholar 

  10. Izquierdo L, Peri L, Piqueras M, Revuelta I, Alvarez-Vijande R, Musquera M, Oppenheimer F, Alcaraz A (2010) Third and fourth kidney transplant: still a reasonable option. Transplant Proc 42(7):2498–2502

    Article  CAS  Google Scholar 

  11. Nourbala MH, Ghaheri H, Kardavani B (2007) Our experience with third renal transplantation: results, surgical techniques and complications. Int J Urol Off J Jpn Urol Assoc 14(12):1057–1059 ((discussion 1059))

    Google Scholar 

  12. Domagala P, van den Berg T, Tran K, Terkivatan T, Kimenai H, Hartog H, Hesselink DA, Bakker SJL, Ijzermans JN, Pol RA, Minnee RC (2019) Surgical safety and efficacy of third kidney transplantation in the ipsilateral iliac fossa. Ann Transplant 8(24):132–138

    Article  Google Scholar 

  13. Reboux AH, Kamar N, Fort M, Rischmann P, Malavaud B, Cointault O, Abbal M, Durand D, Rostaing L (2005) A third renal transplantation: is it relevant and is it worth it? Transplant Proc 37(10):4199–4202

    Article  CAS  Google Scholar 

  14. Ahmed K, Ahmad N, Khan MS, Koffman G, Calder F, Taylor J, Mamode N (2008) Influence of number of retransplants on renal graft outcome. Transplant Proc 40(5):1349–1352

    Article  CAS  Google Scholar 

  15. Park SC, Moon IS, Koh YB (2006) Second and third kidney transplantations. Transplant Proc 38(7):1995–1997

    Article  CAS  Google Scholar 

  16. Ingsathit A, Kantachuvesiri S, Rattanasiri S, Avihingsanon Y, Premasathian N, Pongskul C, Jittikanont S, Lumpaopong A, Sumethkul V (2013) Long-term outcome of kidney retransplantation in comparison with first kidney transplantation: a report from the Thai Transplantation Registry. Transplant Proc 45(4):1427–1430

    Article  CAS  Google Scholar 

  17. Halawa A (2012) The third and fourth renal transplant; technically challenging, but still a valid option. Ann Transplant 17(4):125–132

    Article  Google Scholar 

  18. Herrero E, Portillo JA, Ballestero R, Correas MÁ, Domínguez M, Ramos E, Del Valle JI, Truan D, Campos F, Zubillaga S, Diego A, Fuentes J, Carrión CJ, Velilla G, Calleja P, Varea R, Gutiérrez JL (2017) Experience with third, fourth and fifth kidney transplants and their complications. Arch Esp Urol. 70(10):815–823

    PubMed  Google Scholar 

  19. Kousoulas L, Vondran FWR, Syryca P, Klempnauer J, Schrem H, Lehner F (2015) Risk-adjusted analysis of relevant outcome drivers for patients after more than two kidney transplants. J Transplant 2015:1–9

    Article  Google Scholar 

  20. Polanco N, González Monte E, Folgueira MD, Morales E, Gutiérrez Martínez E, Bengoa I, Hernández A, Morales JM, Praga M, Andrés A (2015) Everolimus-based immunosuppression therapy for BK virus nephropathy. Transplant Proc 47(1):57–61

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology, University Hospital, 12 de Octubre, Av. de Córdoba s/n, 28041, Madrid, Spain

    Rocío Santos-Pérez de la Blanca, José Medina-Polo, Elena Peña-Vallejo, Manuel Pamplona-Casamayor, Julio Teigell-Tobar, Mario Hernández-Arroyo, José Manuel Duarte-Ojeda, Ángel Tejido-Sánchez, Fernando Cabrera-Meiras, Natalia Miranda-Utrera, Lucía García-González & Alfredo Rodríguez-Antolín

  2. Department of Nephrology, University Hospital, 12 de Octubre, Madrid, Spain

    Esther González-Monte

Authors
  1. Rocío Santos-Pérez de la Blanca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José Medina-Polo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena Peña-Vallejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manuel Pamplona-Casamayor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julio Teigell-Tobar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mario Hernández-Arroyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. José Manuel Duarte-Ojeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ángel Tejido-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fernando Cabrera-Meiras
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Natalia Miranda-Utrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Lucía García-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Esther González-Monte
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Alfredo Rodríguez-Antolín
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: RSPB, JMP. Data acquisition: RSPB, EPV, JTT, MHA, EGM. Data analysis and interpretation: RSPB, JMP. Drafting of the manuscript: RSPB, JMP. Administrative/technical support: EPV, JTT, MHA. Approval of the final manuscript: MPC, JMDO, ATS, FCM, NMU, LGG, ARA.

Corresponding author

Correspondence to Rocío Santos-Pérez de la Blanca.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.

Statement of ethics

Ethics committee approval was not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santos-Pérez de la Blanca, R., Medina-Polo, J., Peña-Vallejo, E. et al. Iterative renal transplantation: our experience on third transplants. Int Urol Nephrol 53, 1097–1104 (2021). https://doi.org/10.1007/s11255-021-02788-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-021-02788-9

Keywords

Search

Navigation