Correspondence

Reuse of a Transplanted Kidney

N Engl J Med 1993; 328:1644June 3, 1993

Article

To the Editor:

Pasic et al. (Feb. 4 issue)1 report the successful reuse of a transplanted heart. In our hospital, Moreno et al.2 reused a liver graft with a favorable result. Recently, we reused a transplanted kidney with a beneficial outcome.

The kidney donor was a 22-year-old man with brain death due to cerebral hemorrhage. The first recipient was a 39-year-old man with end-stage renal disease due to diabetic nephropathy. In August 1992 renal transplantation was performed at another hospital. The cold-ischemia time was 20 hours. After reperfusion, diuresis began, and the patient's renal function improved. The patient was treated with azathioprine, prednisone, cyclosporine, and OKT3 monoclonal antibody. On the eighth postoperative day he had an intracranial hemorrhage and was pronounced brain-dead. Reuse of the transplanted kidney was considered. The graft was removed and sent to our center.

The second recipient was a 39-year-old man with end-stage renal disease due to chronic glomerulonephritis. The cold-ischemia time was eight hours. After reperfusion, the patient underwent diuresis and his serum creatinine level decreased. The immunosuppressive protocol included prednisone, azathioprine, cyclosporine, and a cycle of horse antithymocyte globulin. Table 1Table 1Characteristics of the Kidney Donor and Both Recipients. shows HLA matching and the serum creatinine levels of the donor and recipients.

There is a long waiting list for transplantation in both Europe and the United States3,4. If a transplanted kidney works in one patient, it may work in a second patient. Two periods of cold ischemia and immunologic problems may make a graft less likely to be viable. Our patient had immediate renal function with no episodes of rejection.

On the basis of our experience, we recommend that more consideration be given to the reuse of transplanted solid organs in appropriate circumstances. Therefore, we should carefully evaluate all potential donors of solid organs, including transplant recipients whose grafts can be reused.

Amado Andres, M.D.
Jose Maria Morales, M.D.
Hospital 12 de Octubre, 28041 Madrid, Spain

Joseph Lloveras, M.D.
Hospital del'Esperanca, 08024 Barcelona, Spain

4 References

1. 1

   Pasic M, Gallino A, Carrel T, et al. Reuse of a transplanted heart. N Engl J Med 1993;328:319-320
   Full Text | Web of Science | Medline

2. 2

   Moreno EG, Garcia GI, Gonzalez-Pinto I, Gomez SR, Loinaz SC. Successful reuse of a liver graft. Br J Surg 1991;78:813-814
   CrossRef | Web of Science | Medline

3. 3

   European Dialysis and Transplantation Association, European Renal Association. Combined reports on regular dialysis and transplantation in Europe (1986-1990). Madrid: European Dialysis and Transplantation Association, 1990.
   

4. 4

   Levinsky NG, Rettig RA. The Medicare End-Stage Renal Disease Program -- a report from the Institute of Medicine. N Engl J Med 1991;324:1143-1148
   Full Text | Web of Science | Medline

Citing Articles (5)

Citing Articles

1. 1

   Christopher F. Bryan, Bashar Abdulkarim, Jameson Forster, Paul W. Nelson, Dennis Diederich, Daniel Murillo, Lori Markham. (2010) A New Role for the Virtual Crossmatch in Kidney Allograft Reuse. Transplantation 89:6, 764-765
   CrossRef

2. 2

   Ali Celik, Funda Saglam, Caner Cavdar, Aykut Sifil, Ozkan Gungor, Seymen Bora, Huseyin Gulay, Taner Camsari. (2007) Successful Reuse of a Transplanted Kidney: 3-Year Follow-Up. American Journal of Kidney Diseases 50:1, 143-145
   CrossRef

3. 3

   Antonio Lopez-Navidad, Francisco Caballero. (2003) Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool. Clinical Transplantation 17:4, 308-324
   CrossRef

4. 4

   Miguel A. Frutos, Miguel A. Suarez, Julio Santoyo, Cristina Acedo. (2000) SUCCESSFUL TRANSPLANT OF A LIVER FROM A KIDNEY TRANSPLANT RECIPIENT 11 YEARS AFTER TRANSPLANTATION. Transplantation 69:6, 1225
   CrossRef

5. 5

   J. Friedrich, R. Lange, J. Erhard, M. Malago, F. Danninger, J. Kemnitz. (1997) Successful regretting of a transplanted liver. Transplant International 10:3, 245-246
   CrossRef