Imunological aspects of kidney retransplantation

Abstract

The number of patients on the waiting list for a kidney retransplant has increased. Patients who are candidates for a second kidney transplant often have higher levels of PRA (Panel of Reactive Antibodies). The previous failed kidney transplant is one of the main factors that leads to the production of antibodies against human leukocyte antigens ‒ HLA. The consequences of sensitisation are a long waiting time for repeated kidney transplantation and a negative effect on graft survival after retransplantation.The aim of our analysis was to evaluate the immunological parameters of patients undergoing renal retransplantation at the Kosice Transplant Centre, their influence on graft function, the occurrence of rejection episodes and to analyse the sensitisation status of recipients on the waiting list for renal retransplantation at the Kosice Transplant Centre.We retrospectively analysed 46 adult patients who underwent secondary renal transplantation. In the group of retransplanted patients, we found a higher immunological risk and PRA values (p<0.001) and a higher need for induction therapy to reduce the lymphocyte count (p<0.001). Retransplant patients with DGF were 48% more likely to experience acute rejection.In the context of the published literature, we have observed increased sensitisation in retransplanted patients, which is a major challenge to overcome the immunological barrier in transplantation medicine (Tab. 4, Fig. 1, Ref. 24). Keywords: retransplantation, sensitisation, panel of reactive antibodies.