Document Detail


The third and fourth renal transplant; technically challenging, but still a valid option.
MedLine Citation:
PMID:  23274333     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
At present, first and second kidney transplantation have established surgical techniques with few variations between surgeons. They also are considered the best renal replacement therapy for patients with end stage renal disease. Both offer better quality of life and longer survival compared to dialysis. However the third and fourth transplants are significantly more complex. Patients are often highly sensitized, comorbid with limited surgical options due to the previous operations, immunosuppression and long periods on dialysis. There is an incorrect belief that third and fourth retransplantation will not offer any advantage to this cohort of patients and considered to be poor utilization of the limited supply of organs. Recent work demonstrated that third and fourth transplantation offers a survival advantage however it slightly inferior to first and second transplantation, but still there is no established technique. In spite of the surgical challenge, the main cause of graft loss in this cohort of patient is immune mediated rather than the surgical complications. In this review article, we describe various techniques used in transplanting these surgically, immunologically and medically challenging patients demonstrating the effect of surgical complications on the outcome.
Authors:
Ahmed Halawa
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of transplantation : quarterly of the Polish Transplantation Society     Volume:  17     ISSN:  2329-0358     ISO Abbreviation:  Ann. Transplant.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-05-28     Revised Date:  2013-06-17    
Medline Journal Info:
Nlm Unique ID:  9802544     Medline TA:  Ann Transplant     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  125-32     Citation Subset:  IM    
Affiliation:
Sheffield Teaching Hospitals, Sheffield Kidney Institute, University of Sheffield, Sheffield, U.K. ahmed.halawa@sth.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Humans
Kidney Failure, Chronic / mortality,  surgery*
Kidney Transplantation / methods*,  mortality
Reoperation
Transplantation, Heterotopic / methods
Treatment Outcome

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