Early but not late allograft nephrectomy reduces allosensitization after transplant failure

Authors

  • Alp Sener Department of Surgery, Division of Urology, Multi-Organ Transplant Program, UBC, Vancouver, BC
  • Anand K. Khakhar Apollo Hospitals, Department of Transplantation, Chennai, India
  • Christopher Y. Nguan Department of Surgery, Division of Urology, University of British Columbia, Vancouver, BC
  • Andrew A. House Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC and University of Western Ontario, London, ON
  • Anthony M. Jevnikar Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC and University of Western Ontario, London, ON
  • Patrick P. Luke Department of Surgery, Division of Urology, Multi-Organ Transplant Program, UBC, Vancouver, BC

DOI:

https://doi.org/10.5489/cuaj.759

Abstract

Introduction: Allosensitization is a significant obstacle to retransplantation
for patients with primary renal graft failure.

Methods: We assessed the impact of allograft nephrectomy
(Group I) and weaning of immunosuppression (Group II) on percent
panel reactive antibody (%PRA) at various time points after graft
failure in 132 patients with a median follow-up of 47 months. Of
these, 68% had allograft nephrectomy while 32% were placed on
the waiting list and were either taken off immunosuppression, left
on prednisone or on low-dose immunosuppressive therapy.

Results: When groups were stratified into early (<6 months) and
late (>6 months) graft failure, patients who had transplant nephrectomy
for early failure demonstrated a decline in %PRA from
46% at time of graft failure to 27% at last follow-up (p = 0.02);
conversely, %PRA continued to rise in Group II experiencing early
allograft failure. Both Groups I and II patients with late graft failure
maintained elevated %PRA at last follow-up.

Conclusion: Allograft nephrectomy may play a role in limiting
allosensitization in patients with early but not late graft failures.
Résumé

Introduction : L’allosensibilisation est un obstacle important à la
retransplantation chez les patients présentant un échec primaire
de la greffe rénale.

Méthodologie : Nous avons évalué l’impact d’une néphrectomie
du greffon (groupe I) et du sevrage de l’immunosuppression (groupe
II) sur le taux d’immunisation (PRA pour panel reactive antibody) à
différents points dans le temps après l’échec de la greffe chez 132
patients; le suivi médian était de 47 mois. Sur les 132 patients, 68
% ont subi une néphrectomie du greffon, tandis que 32 % ont été
placés sur la liste d’attente, et on a soit mis fin à leur traitement
d’immunosuppression, soit poursuivi leur traitement par prednisone
ou par un agent immunosuppresseur à faible dose.

Résultats : Lorsque les groupes ont été stratifiés en fonction de
l’échec précoce (< 6 mois) et tardif (> 6 mois) de la greffe, les
patients qui ont subi une néphrectomie du greffon en raison d’un
échec précoce ont montré une baisse du PRA, passant de 46 %
au moment de l’échec de la greffe à 27 % lors du dernier suivi
(p = 0,02); en revanche, le PRA a continué d’augmenter chez les
patients du groupe II qui ont présenté un échec précoce de la greffe.
Dans les deux groupes, les patients ayant présenté un échec tardif
de la greffe présentaient toujours un PRA élevé lors du dernier suivi.

Conclusion : La néphrectomie du greffon peut contribuer à limiter
l’allosensibilisation dans les cas d’échec précoce de la greffe, mais
pas dans les cas d’échec tardif.

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Author Biographies

Alp Sener, Department of Surgery, Division of Urology, Multi-Organ Transplant Program, UBC, Vancouver, BC

Anand K. Khakhar, Apollo Hospitals, Department of Transplantation, Chennai, India

Christopher Y. Nguan, Department of Surgery, Division of Urology, University of British Columbia, Vancouver, BC

Andrew A. House, Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC and University of Western Ontario, London, ON

Anthony M. Jevnikar, Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC and University of Western Ontario, London, ON

Patrick P. Luke, Department of Surgery, Division of Urology, Multi-Organ Transplant Program, UBC, Vancouver, BC

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How to Cite

Sener, A., Khakhar, A. K., Nguan, C. Y., House, A. A., Jevnikar, A. M., & Luke, P. P. (2013). Early but not late allograft nephrectomy reduces allosensitization after transplant failure. Canadian Urological Association Journal, 5(6), E142-E147. https://doi.org/10.5489/cuaj.759

Issue

Vol. 5 No. 6 (2011): December

Section

Original Research

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