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Beyond the Limits: How to Avoid a Surgical Nightmare in the Third and Subsequent Renal Transplantation Procedures

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Approximately, 25% of the patients with ESRD will enter the waiting list for kidney transplantation. Among these patients, almost 15% will require a retransplantation surgery. This review aims to summarize the most recent information on different controversial issues regarding retransplantation, to provide the reader with a clear and updated view on the topic.

Recent Findings

Despite current evidence is mainly based on retrospective, small, single-center experiences, it seems clear that retransplantation remains a surgical and immunological challenge, for which the perioperative management still remains crucial to avoid mishaps. Different surgical approaches have been tested, but the general consensus advocates for the heterotopic extraperitoneal in first instance.

Summary

Although higher immunological risk and complication rates are reported invariably in the available series, the benefits in terms of overall survival are superior to those obtained under dialysis, thus still representing the most recommended option for this group of patients.

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References

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  1. Hornberger JC, Best JH, Garrison LP Jr. Cost effectivenes of repeat medical procedures: kidney transplantation as an example. Med Dec Making. 1997;17:363–72.

    Article  CAS  Google Scholar 

  2. Ooms LSS, Roodnat JI, Dor FJ, et al. Kidney retransplantation in the ipsilateral iliac fossa: a surgical challenge. Am J Transpl. 2015;15:2947–54.

    Article  CAS  Google Scholar 

  3. Redfield RR, Gupta M, Rodriguez E, Wood A, Abt PL, Levine MH. Graft and patient survival outcomes of a third kidny transplant. Transplantation. 2015;99:416–23.

    Article  CAS  Google Scholar 

  4. Di Tonno P, Lucarelli G, Battaglia M. Chapter 20: failing graft and retransplantation issues. In: Figueiredo A, Lledó E, editors. European textbook on kidney transplantation. Publisher: European Association of Urology-ESTU; 2017. p. 415–25.

    Google Scholar 

  5. Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57:307–13.

    Article  CAS  Google Scholar 

  6. Rao PS, Schaubel DE, Wei G, Fenton SS. Evaluating the survival benefit of kidney retransplantation. Transpl. 2006;82:669–74.

    Article  Google Scholar 

  7. Healphy EL, Poggio ED, Flechner SM, Goldfarb DA, Askar M, Fatica R, et al. Risk factors for retransplant kidney recipients: relisting and outcomes from patients primary transplant. Am J Transplant. 2014;14:1356–67.

    Article  Google Scholar 

  8. Abouljoud MS, Dejerhoi MH, Hudson SL, Diethelm AG. Risk factors affecting second renal transplant outcome with spcial reference to primary allograft nephrectomy. Transplantation. 1995;60:138–44.

    Article  CAS  Google Scholar 

  9. Cicciarelli J, Shah T, Koss M, Houston K, Naraghi R. Renal graft loss in recipients with at least one year of function and donor specific antibody (DSA). Clinical Transplant. 2006:539–40.

  10. Arndorfer JA, Meier Kriesche HU, Ojo AO, Gruber SA, Cibrik DM, Lake KD, et al. Time to first graft loss as a risk factor for second renal allograft loss. Transpl Proc. 2001;33:1113–4.

    Article  Google Scholar 

  11. Kienzl-Wagner K, Mark W, Maglione M. Single-center experience with third and fourth kidney transplants. Transpl Int. 2011;24:780–6.

    Article  Google Scholar 

  12. Mazzuchi E, Danilovic A, Antonopoulos IM. Surgical aspects of third and subsequent renal transplants performed by extraperitoneal access.Transplantation 2006; 81: 840–44.

  13. Chedid MF, Moreno Gonzales M, Raghavaiah S, Chauhan A, Taner T, Nedredal GI, et al. Renal retransplantation after kidney and pancreas transplantation using the renal vessels of the failed allograft: pitfalls and pearls. Clin Transpl. 2014;28:669–74.

    Article  Google Scholar 

  14. Nghiem D. Orthotopic kidney retransplantation in simultaneous pancreas kidney transplant patients with renal failure. Transpl Proc. 2008;40:3609–10.

    Article  CAS  Google Scholar 

  15. Van Poppel H, Gil Vernet JM. Simultaneous splenectomy and orthotopic kidney transplantation. Acta Urol Belg. 1985;53:685–92.

    PubMed  Google Scholar 

  16. Gil Vernet JM, Gil Vernet A, Caralps A, Carretero P, Talbot-Wright R, Andreu J, et al. Orthotopic renal transplant and results in 139 consecutive cases. J Urol. 1989;142:248–52.

    Article  CAS  Google Scholar 

  17. Musquera M, Peri L, Alvarez-Vijande R, Oppenheimer F, Gil-Vernet JM, Alcaraz A. Orthotopic kidney transplantation: an alternative surgical technique in selected patients. European Urology 2010; 58: 927–933 (* Most updated and largest experience on orthotopic renal transplantation).

  18. Loupy A, Anglicheau D, Timsit MO, Thervet E, Mamzer-Brunner MF, martine F, Desgrandchamps F, Thionun N, Kreis H, Legendre C, Chretien Y, Mejean A. Impact of surgical procedures and complications on outcomes of third and subsequent kidney transplants. Transplantation 2007; 83: 385–391.

  19. Gutierrez Baños JL, Calabia ER, Rebollo Rodrigo M, Portillo Martin J, Correas Gomez MA. Aspectos quirúrgicos y complicaciones derivadas de la reutilización de la fosa iliaca en terceros y cuartos retrasplantes renales. Arch Esp Urol. 2005;58:121–9.

    Article  Google Scholar 

  20. Herrero E, Portillo JA, Ballestero R, Correas MA, Varea R, Gutiérrez JL. Experience with thrid, fourth and fifth kidney transplants and their complications. Arch Esp Urol. 2017;70:815–23.

    PubMed  Google Scholar 

  21. Bösmüller C, Maglione M, Margreiter C, Dziodzio T, Biebl M, Pratschke J, et al. Succesful combined fourth kidney third and pancreas third-kidney second transplantation: a case report. Transplant Direct. 2015;24:e22.

    Google Scholar 

  22. Izquierdo L, Peri L, Piqueras M, Revuelta I, Alvarez-Vijande R, Musquera M, et al. Third and fourth kidney transplants: still a reasonable option. Transplant Proc. 2010;42:2498–502.

    Article  CAS  Google Scholar 

  23. Nourbala MH, Ghaheri H, Kardavani B. Our experience with third renal transplantation: results, surgical techniques and complications. Int J Urol. 2007;14:1057–9.

    Article  Google Scholar 

  24. Hagan C, Hickey DP, Little DM. A single-center study of the technical aspects and outcome of thrid and subsequent renal transplants. Transplantation. 2003;75:1687–91.

    Article  Google Scholar 

  25. Halawa A. The third and fourth renal transplant: technically challenging but still a valid option. Ann Transplant. 2012;17:125–32.

    Article  Google Scholar 

  26. Lledó-Garcia E, Hernández-Fernández C, Subirá-Ríos D, Díez-Cordero JM, Herranz-Amo F, Verdú-Tartajo F, Luque de Pablos A. Cadaver donor kidney retransplantation in the pediatric patient. Complications and long-term outcome. J Urol 2011; 185: 2582–2585.

  27. Ahlawatt R, Arora S. Robotic kidney transplant. In: Figueiredo A, Lledó E, editors. European textbook on kidney transplantation. Publisher: European Association of Urology-ESTU; 2017. p. 569–85.

    Google Scholar 

  28. Spaggiari M, Lendacki FR, Di Bella C, Giulanotti PC, Benedetti E, Oberholzer J, et al. Minimally invasive, robot-assisted procedure for kidney transplantation among morbidly obese: positive outcomes at 5 years post-transplant. Clin Transpl. 2018;32:e13404.

    Article  Google Scholar 

  29. Ahlawatt RK, Tugcu V, Arora S, Wong P, Sood A, Jeong W, et al. Learning curves and timing of surgical trials: robotic kidney transplantation with regional hypothermia. J Endourol. 2018;32:1160–5.

    Article  Google Scholar 

  30. Decaestecker K, Breda A, Territo A, et al. The European experience on robot-assisted kidney transplantation: 2 years after the beginning. Eur Urol Suppl 2018; 17(2): e966. (** Most updated current European experience on robotic-assisted renal transplantation).

  31. Rodriguez-Faba O, Boissier R, Budde K, et al. European Association of Urology guidelines on renal transplantation: update 2018. Eur Urol Focus 2018; 4:208–215. (* Updated European Guidelines on kidney transplantation).

  32. Dabare D, Kassimatis T, Hodson J, Khurram MA, Papadakis G, Olsburgh J, et al. Outcomes in third and fourth kidney transplants based on the type of donor. Transplantation. 2019;103:1494–503.

    Article  CAS  Google Scholar 

  33. Barnes JCH, Goodyear SJ, Imray CEA, Lam FT, Kashi HS, Tan LC, et al. Kidney retransplantation from HLA-incompatible living donors: a single-center study of 3rd/4th transplants. Clin Transpl. 2017;31. https://doi.org/10.1111/ctr.13104.

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Authors and Affiliations

  1. Adult & Pediatric Kidney Transplant Program, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, C/Doctor Esquerdo, 46, 28007, Madrid, Spain

    Enrique Lledó-García, Javier González, Elena Martínez-Holguín, Felipe Herranz-Amo & Carlos Hernández-Fernández

Authors
  1. Enrique Lledó-García
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  2. Javier González
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  3. Elena Martínez-Holguín
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  4. Felipe Herranz-Amo
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  5. Carlos Hernández-Fernández
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Correspondence to Enrique Lledó-García.

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Conflict of Interest

Enrique Lledó-García, Javier González, Elena Martínez-Holguín, Felipe Herranz-Amo, and Carlos Hernández-Fernández each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Lledó-García, E., González, J., Martínez-Holguín, E. et al. Beyond the Limits: How to Avoid a Surgical Nightmare in the Third and Subsequent Renal Transplantation Procedures. Curr Urol Rep 21, 13 (2020). https://doi.org/10.1007/s11934-020-0964-7

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  • DOI: https://doi.org/10.1007/s11934-020-0964-7

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