Equivalent outcomes with primary and retransplantation in African-American deceased-donor renal allograft recipients
| Autor: | Jose M. El-Amm, Julian E. Losanoff, Sandra L. Nehlsen-Cannarella, Atul Singh, Mona D. Doshi, Elizabeth Cincotta, Miguel S. West, Kristian L. Brown, Kalyani Mehta, Katherina Morawski, Scott A. Gruber |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Urinary system Gastroenterology chemistry.chemical_compound Prednisone Internal medicine Diabetes mellitus medicine Humans Transplantation Homologous Retrospective Studies Creatinine Kidney Thymoglobulin business.industry Histocompatibility Testing Graft Survival HLA-DR Antigens Middle Aged medicine.disease Kidney Transplantation Tissue Donors Tacrolimus Surgery Black or African American surgical procedures operative medicine.anatomical_structure chemistry Sirolimus Female business medicine.drug |
| Zdroj: | Surgery. 146:646-653 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2009.05.020 |
| Popis: | Background Graft survival following renal retransplantation has been inferior to that following primary allografting, particularly in African Americans (AAs) receiving deceased-donor (DD) kidneys. Methods Among 166 AA DD renal allograft recipients transplanted from July 2001 through July 2007, we compared the outcomes of 26 (16%) receiving a second graft with those of 140 primary cases. All patients received either thymoglobulin (ATG) or an IL-2 receptor antagonist for induction, and were maintained on either tacrolimus or sirolimus + mycophenolate mofetil ± prednisone. Results When compared with primary transplants, regrafts received kidneys from older donors, were younger, more sensitized, more likely to receive ATG and to be maintained on prednisone, received more doses of ATG, and were less likely diabetic. There was no difference between primary and retransplant groups in overall patient or graft survival; incidence of acute rejection, CMV infection, BK nephropathy, or new-onset diabetes mellitus; and serum creatinine at 1 year. Conclusion AA renal allograft recipients can undergo a second DD transplant with intermediate-term outcomes comparable to that of a primary graft, despite the presence of multiple immunologic and non-immunologic high-risk factors, by extending the course of ATG induction and continuing prednisone therapy in the vast majority of cases. |
| Databáze: | OpenAIRE |
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