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Selective retransplant after graft loss to nonadherence: success with a second chance. Am J Transplant 2009 Jun;9(6):1337-46

Date

05/23/2009

Pubmed ID

19459828

Pubmed Central ID

PMC3553599

DOI

10.1111/j.1600-6143.2009.02625.x

Scopus ID

2-s2.0-66249121006 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

Nonadherence (NA) is a difficult posttransplant problem that can lead to graft loss. A retransplant is controversial because of a fear of recurrent NA. We reviewed our center's data base and identified 114 kidney recipients who lost their graft to overt NA; of this group, 35 (31%) underwent a retransplant after a thorough reevaluation. We compared this NA retransplant group to a control group of second transplant recipients who did not lose their first graft to overt NA (non-NA) (n = 552). After 8 years of follow-up, we found no significant differences between the groups in actuarial graft or patient survival rates, renal function, or the incidence of biopsy-proven chronic rejection. However, 5 of 35 (14%) NA recipients versus 10 of 552 (2%) non-NA recipients lost their retransplant to NA (p = 0.0001). Twenty of 35 (57%) of the NA group exhibited repeat NA behavior after retransplant. We conclude that prior graft loss to NA is associated with increased graft loss to NA after retransplant. However, the majority of NA retransplant recipients did well-with overall long-term outcomes similar to those of the non-NA group. With careful patient selection and aggressive intervention, prior overt NA should not be an absolute contraindication to retransplantation.

Author List

Dunn TB, Browne BJ, Gillingham KJ, Kandaswamy R, Humar A, Payne WD, Sutherland DE, Matas AJ

Author

Ty Blink Dunn MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Female
Graft Rejection
Graft Survival
Humans
Kidney Transplantation
Male
Middle Aged
Patient Care Team
Patient Compliance
Patient Selection
Reoperation
Tissue and Organ Procurement
Treatment Outcome