Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2005) 67, 2368–2375; doi:10.1111/j.1523-1755.2005.00343.x
The effect of a first kidney transplant on a subsequent transplant outcome: An experimental and clinical study
DAVID LAIR1, STÉPHANIE COUPEL2, MAGALI GIRAL, MARYVONNE HOURMANT, GEORGES KARAM, CLAIRE USAL, JEAN DENIS BIGNON, SOPHIE BROUARD and JEAN-PAUL SOULILLOU
Institut National de la Santé Et de la Recherche Médicale (I.N.S.E.R.M.)–Unité 643: "Immunointervention dans les Allo et Xenotransplantations" and Institut de Transplantation Et de Recherche en Transplantation (I.T.E.R.T.), CHU-Hotel Dieu, Nantes Cedex, France; and Blood Bank, HLA Typing Laboratory, Nantes, France
Correspondence: Pr. Jean-Paul Soulillou, I.N.S.E.R.M. U643, CHU-HOTEL DIEU, 30 bd. Jean Monnet, 44093 Nantes Cedex 01, France. E-mail:Jean-Paul.Soulillou@univ-nantes.fr
1and
2contributed similarly as first authors and senior investigators, respectively.
Received 7 July 2004; Revised 15 October 2004; Re-revised 4 January 2005; Accepted 20 January 2005.
Abstract
The effect of a first kidney transplant on a subsequent transplant outcome: An experimental and clinical study.
Background
Second kidney transplantations have a roughly similar clinical outcome to first transplantations. Nevertheless, the effect of the presence of the first, nonfunctional transplant at the time of the second transplantation may also influence its outcome and has not yet been specifically studied.
Methods
We analyzed the effect of the presence of a first graft on the outcome of a second graft in a rodent allograft model and in a cohort of 240 human second kidney allograft recipients.
Results
In rodents, 100 days subsequent to the rejection of the first graft, we observed an increase in blood but not spleen CD4+CD25+ T cells, whereas no differences were observed in transcriptional patterns. Adoptive transfer of day 100 splenocytes did not prolong graft survival. Moreover, the presence of a first rejected graft does not prolong the survival of a second graft performed at a later date. In the human context, a higher incidence of patients with anti-HLA immunization and a higher % of PRA were observed in retransplant recipients with primary allograft nephrectomy. Despite a relatively low statistical power, our data do not suggest significant differences in graft outcome between recipients of second transplants with primary allograft nephrectomy and those without.
Conclusion
Collectively, the data from both an experimental model and a large cohort of human recipients of a second graft do not suggest a beneficial effect of the presence of a first rejected graft at the time of a second transplantation.
Keywords:
transplantation, experimental and clinical study, kidney, second transplant
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