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April 1994

Second Renal TransplantationsEthical Issues Clarified by Outcome; Outcome Enhanced by a Reliable Crossmatch

Author Affiliations

From the Transplantation Unit, General Surgical Services, the Massachusetts General Hospital and the Departments of Surgery and Medicine, Harvard Medical School, Boston.

Arch Surg. 1994;129(4):354-360. doi:10.1001/archsurg.1994.01420280024003

Objective:  To determine whether the appropriate use of scarce donor resources has been accomplished by renal retransplantation by reviewing the initial and long-term outcomes of second—renal transplant recipients at the Massachusetts General Hospital, Boston.

Patients and Results:  With a mean follow-up of nearly 5 years following transplantation, 54 (68%) of 80 second-transplant recipients had functioning allografts (allograft failure was defined by patient death or a return to dialysis). Rejection was the most common cause of failure (14 [54%] of 26 patients). The 1-, 3-, and 5-year actuarial allograft survival rates were 86%, 78%, and 69%, respectively, which were not significantly different from the survival rates of primary allografts at this center. These results support the continued approach of providing both cadaver-donor and living-donor renal allografts for recipients whose primary renal allograft has failed. The antiglobulin crossmatch may have contributed to the successful outcome by accurately determining compatibility and by averting early rejection failures.

Conclusions:  Health care policy reviewers should clearly distinguish the prospects for successful second renal transplants from the outcomes of extrarenal retransplantation. Moreover, because excellent second—renal allograft survival is attainable and comparable to primary—renal allograft survival and because the costs are comparable, restricting suitable patients to subsequent lifelong dialysis becomes unethical.(Arch Surg. 1994;129:354-360)