Marcén, Roberto; Fernández, Ana; Lucas, Milagros Fernández; Teruel, José Luis; Pérez-Flores, Isabel; Sánchez-Fructuoso, Ana
February 2009
Nefrologia;Feb2009 Supplement, Vol. 29 Issue S1, p62
Academic Journal
Despite the advances in immunosuppressive therapy and in patient care, about 20-30% of patients will have lost their grafts after 3 years and this loss will continue by 3-4% per year. These patients are included in maintenance dialysis programmes and account for 4 to 10% of those admitted every year for maintenance dialysis therapy. Among those patients who loss their grafts 40- 60% are included in transplant waiting l ists. This increases the number of patients waiting for a graft and raises the di lemma about the rights to be included in deceased donor programmes. A common characteristic of these patients waiting for a second or even third transplant is the presence in the blood of antibodies to HLA antigens. A new transplant is the best therapeutic option for these patients, and the results are quite close to those achieved for the first graft. Moreover, a new transplant improves patient outcome when compared with those remaining in the waiting l ist. The best results are obtained in diabetic patients and in those between 18 to 50 years old (Evidence C). However, the percentage of patients retransplanted has not varied in the last years, possibly due to the wider criteria adopted on candidate selection that increases the waiting l ists (Evidence B). In the second transplant, mismatched HLA-A,B antigens could be repeated if the recipient has not developed specific antibodies to these antigens. Recent cross-match has to be negative. Immunosuppressive therapy is simi lar to that used with first transplants. Lymphoprol iferative diseases, BK virus nephropathy and primary glomerulonephri - tis do not preclude a second transplant (Evidence C).


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