Early but not late allograft nephrectomy reduces allosensitization after transplant failure

摘要

Introduction: Allosensitization is a significant obstacle to retransplantation for patients with primary renal graft failure. Methods: We assessed the impact of allograft nephrectomy (Group I) and weaning of immunosuppression (Group II) on percent panel reactive antibody (%PRA) at various time points after graft failure in 132 patients with a median follow-up of 47 months. Of these, 68% had allograft nephrectomy while 32% were placed on the waiting list and were either taken off immunosuppression, left on prednisone or on low-dose immunosuppressive therapy. Results: When groups were stratified into early (6 months) graft failure, patients who had transplant nephrectomy for early failure demonstrated a decline in %PRA from 46% at time of graft failure to 27% at last follow-up ( p = 0.02); conversely, %PRA continued to rise in Group II experiencing early allograft failure. Both Groups I and II patients with late graft failure maintained elevated %PRA at last follow-up. Conclusion: Allograft nephrectomy may play a role in limiting allosensitization in patients with early but not late graft failures.