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IDENTIFICATION OF PARAMETERS THAT CONTRIBUTE TO A SUCCESSFUL KIDNEY RETRANSPLANTATION.
Ilias Doxiadis 1,2, Johan de Fijter 3, Geert Haasnoot 1, Marko Mallat 3, Guido Persijn 4 and Frans Claas 1,2. 1 Immunohaematology and Blood Transfusion, LUMC, Leiden, Netherlands ; 2 Eurotransplant Reference Laboratory, LUMC, Leiden, Netherlands ; 3 Neprhology, LUMC, Leiden, Netherlands and 4 Eurotransplant International Foundation, Leiden, Netherlands .
About 25% of the patients on the kidney waiting list are retransplant candidates. Compared to primary grafts these patients have a higher incidence of graft loss, due to the sensitization by the primary graft. Discussion is emerging whether it is ethical to offer organs to this type of high-risk patients. We analyzed all retransplants performed from 1985 - 1996 (N = 9571) within Eurotransplant, and performed a multivariate analysis asking for the factors independently influencing graft outcome. Donor age, transplantation period, sensitization and HLA matching were found to be independent parameters influencing graft survival. The hazards ratio (HR) of these factors varied between 1.42 - 1.92. In a consecutive study (1996 - 2004, N = 3826 retransplants) we questioned the value of the dogma of repeated mismatches, earlier reported to be deleterious for the consecutive grafts. Repeated HLA-A, B and HLA-DQ mismatches had no influence on graft outcome. Repeated HLA-DR mismatches in sensitized patients were found to influence graft outcome in multivariate analysis (HR = 2.35). Finally, we questioned the influence of specific HLA-DR antigens expressed by the recipient on the outcome of the retransplant. In a multivariate analysis we observed that, patients expressing HLA-DR1 and/or HLA-DR5 have a significantly higher graft survival than patients not expressing these antigens (HR = 0.77 and HR = 0.79 respectively). We conclude that histocompatibility related parameters significantly contribute to the success of a retransplantation.