Kidney re-transplantation in the ipsilateral iliac fossa: a surgeon's perspective on perioperative outcome

Philipp Tessmer; Clara A Weigle; Anna Meyer; Bengt A Wiemann; Wilfried Gwinner; Gunilla Einecke; Jürgen Klempnauer; Florian W R Vondran; Nicolas Richter; Felix Oldhafer; Oliver Beetz

doi:10.1093/ckj/sfae271

Kidney re-transplantation in the ipsilateral iliac fossa: a surgeon's perspective on perioperative outcome

Clin Kidney J. 2024 Sep 2;17(9):sfae271. doi: 10.1093/ckj/sfae271. eCollection 2024 Sep.

Authors

Philipp Tessmer¹, Clara A Weigle¹, Anna Meyer¹, Bengt A Wiemann¹, Wilfried Gwinner², Gunilla Einecke^{2

3}, Jürgen Klempnauer¹, Florian W R Vondran^{1

4}, Nicolas Richter¹, Felix Oldhafer^{1

4}, Oliver Beetz^{1

4}

Affiliations

¹ Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
² Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
³ Department of Nephrology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany.
⁴ Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany.

Abstract

Background: Compared with primary transplantation, ipsilateral renal re-transplantation is associated with an increased risk of surgical complications and inferior graft outcomes. This study investigates whether an ipsilateral re-transplantation approach per se is an independent risk factor for surgical complications and early graft loss.

Methods: In this retrospective, single-centre analysis, surgical complications and early graft outcomes of ipsilateral kidney re-transplantations from January 2007 to December 2017 were compared with primary transplantations and contralateral re-transplantations. Univariate and multivariate binary logistic regression analyses were performed to identify risk factors for surgical complications requiring surgical revision and graft loss within the first year after transplantation.

Results: Of the 1489 kidney transplantations, 51 were ipsilateral, 159 were contralateral re-transplantations and 1279 were primary transplantations. Baseline characteristics did not differ between the ipsilateral and contralateral re-transplant recipients except for current and highest panel reactive antibody levels. Major complications requiring surgical revision were significantly more frequent in ipsilateral re-transplantations (P = .010) than in primary transplantations but did not differ between ipsilateral and contralateral re-transplantations (P = .217). Graft loss within the first year after transplant was 15.7% in the ipsilateral versus 8.8% in the contralateral re-transplant group (P = .163) versus 6.4% in the primary transplantation group (P = .009). In a multivariate regression model, ipsilateral re-transplantation was not identified as an independent risk factor for complications requiring surgical revision or first-year graft loss.

Conclusions: Ipsilateral renal re-transplantation is not a risk factor for inferior outcomes. Graft implantation into a pre-transplanted iliac fossa is a feasible and valid therapeutic option.

Keywords: graft failure; ipsilateral renal re-transplantation; iterative kidney transplantation; kidney re-transplantation; surgical complications in kidney re-transplantation.