DOMINO PROCEDURE IN KIDNEY-TRANSPLANTATION - A WAY TO EXPAND ORGAN RESOURCES

A 43-year-old male patient suffering from chronic renal failure for 10 years had been transplanted in July 1993 with a cadaveric kidney from a 37-year-old female donor with identical HLA type. The primary funct ion was excellent and creatinine levels remained between 1.1 and 1.4 m g/dL for 2 years. In September 1995 the patient developed spontaneous intracerebral bleeding, with subsequent brain death. Because of the ex cellent organ function and in consent with the patient's wife, we cons idered retransplanting the already once-grafted kidney. The kidney was retransplanted into a 66-year-old woman with chronic renal failure du e to glomerulonephritis. The immunosuppression consisted of FK 506 and cortisone. The patient has had an excellent kidney function (creatini ne 0,9 mg/dL) for 11 months. The chronic shortage of transplantable or gans motivates physicians to seek alternative resources. Reusing of tr ansplanted organs is a rare event, and has been described fur heart,(1 ) liver,(2) and kidney.(3) However, in all previous reported cases the time span between first and second transplantation was only a few hou rs or days. More than 500,000 organ transplantations have been perform ed worldwide. For these patients the risk for hypertension(4) and subs equent cerebrovasculare disease(5) increases considerably compared wit h the normal population.(6) Therefore, physicians will be confronted w ith the situation that transplant recipients become potential organ do nors more often in the future. This case shows that retransplantation of a long-term grafted kidney is technically possible and can result i n an excellent organ function.