1.Immunologic and non-immunologic complications of a third kidney transplantation.
Hyun Seon KIM ; Jae Young KIM ; Eun Jin KANG ; Yoon Seok CHOI ; Ji Il KIM ; In Sung MOON ; Bum Soon CHOI ; Cheol Whee PARK ; Chul Woo YANG ; Yong Soo KIM ; Byung Ha CHUNG
The Korean Journal of Internal Medicine 2015;30(5):657-664
BACKGROUND/AIMS: Patients who undergo repeat kidney transplantations (KTs) are considered at high risk for experiencing immunologic and non-immunologic complications. In this study, we investigated the clinical outcomes, including medical and surgical complications, of patients who underwent a third KT at our center. METHODS: Between March 1969 and December 2012, a total of 2,110 KTs were performed at the Seoul St. Mary's Hospital. Of them, we examined 11 patients who underwent a third KT, and investigated the allograft outcomes and complication rates. RESULTS: The mean follow-up duration after KT was 72.4 ± 78.3 months. The mean age at KT was 38.2 ± 8.0 years, and seven patients (63.6%) were males. Nine patients (81.8%) underwent living-donor KT. A cross-match test yielded positive results in four of the nine patients, and all underwent pretransplant desensitization therapy. After KT, three patients (27.2%) showed delayed graft function. Acute rejection developed in four patients (36.4%), and surgical complications that required surgical correction occurred in three patients. Allograft failure developed due to acute rejection (n = 3) or chronic rejection (n = 1) in four patients. Allograft survival rates at 1, 5, and 10 years were 81.8%, 42.9%, and 42.9%, respectively; however, the allograft survival rate at 5 years was > 80% in patients who underwent KT only after results of the panel reactive antibody test became available. CONCLUSIONS: Thus, a third KT procedure may be acceptable, although aggressive pretransplant immune monitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications.
Acute Disease
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Adult
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Allografts
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Chronic Disease
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Delayed Graft Function/diagnosis/*etiology/therapy
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Female
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Graft Rejection/diagnosis/*immunology/therapy
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Graft Survival
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*Histocompatibility
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Humans
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Immunosuppressive Agents/therapeutic use
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Kidney Transplantation/*adverse effects
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Male
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Middle Aged
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Patient Selection
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Reoperation
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Republic of Korea
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Risk Assessment
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Risk Factors
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Time Factors
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Treatment Outcome