SERIAL RENAL-TRANSPLANT SURGERY - TECHNICAL REFLECTIONS CONCERNING 3RD TRANSPLANTS

From 1972 to 1993, we carried out 803 consecutive renal transplants in cluding 8 third transplants, Exclusively cadaveric, these third renal transplants were implanted by intraperitoneal approach in right iliac position, without previous homolateral transplantectomy in 5 cases. Th e arterial anastomoses were common (7) or external iliac and hypogastr ic (1), and the venous anastomoses external(1) and common iliac (3), o r inferior vena cava (4). Restoration of urinary continuity was by ure teronecystostomy (Politano-Leadbetter = 4, Gregoir-Lich = 3) or ureter oureteric anastomosis (1). The level of HLA compatibility varied from 2 to 5 identities (mean 3.1) and 4 of the 7 patients explored were hyp erimmunized with lymphocytotoxic antibody levels greater than or equal to 80%. With the exception of the first of these third transplants, t he immunosuppressive protocol associated azathioprine, prednisolone, a ntilymphocytic serum and cyclosporin. Postoperative sequels were marke d by 3 vascular rejections and 1 death from hyperkalemia, Moreover, I urinary fistula on ureteroureteric anastomosis settled after percutane ous nephrostomy and placing of an uteric stent endoprosthesis. With a postoperative follow-up of 8-32 months (mean 24), 5 of the transplante d patients (62.5%) have a functional renal transplant with a serum cre atinine from 120 to 180 mu M/l (mean 140). This brief series, whose fa ilures are exclusively immunological, reveals the remarkable technical reliability for these third renal transplants in right iliac implanta tion, by median transabdominal approach and above a former transplant site.