Equivalent outcomes with primary and retransplantation in African-American deceased-donor renal allograft recipients

Background. Graft survival following renal retransplantation has been inferior to that following primary allografting, particularly in African American (AAs) receiving deceased-donor (DD) kidneys Methods. Among 166 AA DD renal allograft recipients transplanied 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 anlagonist for inductio, and were maintained on either tacrolomus or sirolimus + mycophenolate mofehl - preduisone Results. When compared with primary transplants, regrafts received kidneys form older donors, were younger, more sensitized, more likley 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 under and continuing predisone therapy in the vast majority of cases (Surgery 2009:146:646-53)