Does Nephrectomy of Failed Allograft Influence Graft Survival After Re-transplantation?

Background: The aim of the study was to determine the effect of removal of a failed kidney allograft on the outcome of subsequent transplant.

Methods: Retrospective analytical study comparing graft survival for patients (1993-2005) who had previous graft nephrectomy with those who had not.

Results: Of 89 patients with kidney re-transplants, 68 had had a transplant nephrectomy (Group I) while 21 had retained failed grafts (Group II). There was no significant difference in the two groups in the PRA level at the time of re-transplantation (37% versus 29%). Mean follow-up was 47 months. Acute rejections in Group I were 49.1% and in Group II, 31.2% (P = 0.20). Twenty (29%) grafts failed in Group I and four (19%) in Group II. One, three and five years' actuarial graft survival in Group I was 83.8%, 76% and 66.2%, while in Group II, it was 94.7%, 86.8% and 69.5%, respectively (P = 0.66). Five-year actuarial patient survival in Groups I and II was 94.1% and 87.5%, respectively (P = 0.69). Multivariate analysis showed that PRA level significantly influenced graft survival independent of nephrectomy (P = 0.04).

Conclusion: Nephrectomy of a failed allograft does not seem to significantly influence the survival of a subsequent graft.