Kidney Retransplantation: Removal or Persistence of the Previous Failed Allograft? P. Dinis a, *, P. Nunes a , L. Marconi a , F. Furriel a , B. Parada a , P. Moreira a , A. Figueiredo a , C. Bastos a , A. Roseiro a , V. Dias a , F. Rolo a , F. Macário b , and A. Mota a a Department of Urology and Renal Transplantation, and b Department of Nephrology, Coimbra University Hospital, Coimbra, Portugal ABSTRACT A significant percentage of patients with failed renal graft are candidates for retransplantation. The outcomes of retransplantation are poorer than those of primary transplantation and sensitization is documented to be a major reason. The management of a failed allograft that is not immediately symptomatic is still very controversial. The aim of this study was to determine the impact of the failed allograft nephrectomy on a subsequent transplantation and its importance in the sensitization. We performed a retrospective analysis of the local prospective transplantation registry of the outcome of 126 second kidney transplantations among 2438 transplantations performed in our unit between June 1980 and March 2013, comparing those who underwent allograft nephrectomy prior to retransplantation with those who retained the failed graft. Primary endpoints were graft and patient survival. The levels of panel-reactive antibodies (PRA) and rate of acute rejections on retransplantation outcomes were also studied. Among the 126 patients who underwent a second renal transplantation, 76 (60.3%) had a prior graft nephrectomy (Group A), whereas 50 (39.7%) kept their failed graft (Group B). Group A showed significantly more positive PRA levels when compared with the other group (38% vs 10%; P < .001), as measured before the most recent transplantation, and a higher rate of acute rejection (19% vs 5.6%; P ¼ .016). There were 28 (36%) renal allograft losses for Group A and 18 (36%) for those who had not had transplantectomy (P ¼ not sig- nificant [NS]). One-, 3-, and 5-year graft survival rates were 96.6%, 90.7%, and 83.4%, respectively, in Group A and 95%, 82%, and 68.4%, respectively, in Group B, with no sta- tistical differences (P ¼ .19). Five-year actuarial patient survival rates in the 2 groups was 89.3% and 82.8%, respectively (P ¼ .55). Multivariate analysis showed that PRA level and delayed graft function (DGF) had a statistically significant influence on graft survival (P ¼ .028; odds ratio [OR] ¼ 1.029; and P ¼ .024; OR ¼ 8.6), irrespective of whether the patient had graft nephrectomy or not. The allosensitization indicated by PRA increases after trans- plantectomy and leads to a higher incidence of acute rejection after retransplantation. Ne- phrectomy of failed allograft does not seem to significantly influence the survival of a subsequent graft. The decision to remove or retain a failed graft in the context of retrans- plantation should thus be based on known clinical indications for the procedure. O VER the last decades important advances have been made in every aspect of kidney transplantation including the introduction of new and potent immunosup- pressant drugs, resulting in significant improvement of renal allograft survival. Nevertheless, the rate of graft failure re- mains about 10% in the first year, and 3% to 5% each year afterward [1]. As recipients of kidney transplants are growing in absolute numbers, so are patients with failed allografts and thus potential candidates for retrans- plantation. Repeat transplantation is associated with an improved overall survival of patients with a failed renal allograft [2], however, the outcomes of retransplantation are *Address correspondence to Paulo Jorge Sousa Dinis, Serviço de Urologia e Transplantação Renal, CHUC, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal. E-mail: Pj.s.dinis@gmail.com 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2014.05.029 ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 1730 Transplantation Proceedings, 46, 1730e1734 (2014)