Role of Renal Re-transplantation in ESRD Patients

Implication for health policy/practice/research/medical education: It is about the advantages of renal re-transplantation for patients with a history of previous grafting. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Although there is no data to prove the role of renal re-transplantation, but it is presumed to be a favorable option for many patients after graft loss. Re-transplantation often provides a better survival and good health in comparison with dialysis, that is more obvious for younger recipients and whom receives transplantation either preemptively or shortly after the need for renal replacement therapy has arisen (1). Although some authors believe that for older patients, dialysis is a better option (2). Indeed the type of dialysis doesn't have any influence on the outcome of transplantation (3). The etiology of their initial graft loss varies in candidates of kidney re-transplantation depends on the time of graft loss. If graft loss occurred within the first year after transplantation, the most common etiologies are acute rejection and graft thrombosis and if this occurred after 1 year of transplant, chronic rejection accounts for nearly two thirds of the graft loss (4). In recent decades, kidney re-graft survival has been improved and this improvement is more obvious for grafts from cadaveric source (graft half-life has been increased from 2.0 years in 1988 to 7.5 years in 1995) in comparison with living donors (5) and is suggested that this improvement is the result of improved HLA testing and improvements in immunosuppressive agents (1). 5-year survival after re-transplantation in deceased donors and living donors is as the same as primary transplantation in patients with hypertension, diabetes and renovascular diseases but is less favorable in recipients with polycystic kidney disease (PKD) or glomerular disease (6). Many variables have an effect on re-transplantation outcome , such as recipient comorbidities, outcome of primary transplant, risk of recurrent disease and the wait time on dialysis before transplantation (1). CKD will occur in the majority of transplanted kidneys that is due to many etiologies include chronic rejection, recurrent disease , calcineurin toxicity and underlying diseases such as diabetes, hypertension and atherosclerosis (1). Early graft loss after previous transplantation is a pre-dictor of the occurrence of the same process after re-transplantation and so the recipient and potential donors should be evaluated very precisely. This early graft rejection can be due to many factors such as acute rejection …