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08 June 2022 : Original article  

[In Press] Effect of Nephrectomy After Allograft Failure on Inflammation, Erythropoiesis, Donor-Specific Antibodies, and Outcome of Re-Transplantation

Panagiota Zgoura1BC, Adrian Doevelaar1E, Benjamin Rohn1F, Felix S. Seibert1CD, Maximilian Seidel1CD, Falko Markus Heinemann ORCID logo2CD, Nina Pillokeit ORCID logo3E, Richard Viebahn3ABCD, Nina Babel1BCD, Timm H. Westhoff1ACDE

DOI: 10.12659/AOT.935625

Ann Transplant In Press; DOI: 10.12659/AOT.935625  

Available online: 2022-06-08, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Morbidity and mortality rates are high for patients returning to dialysis after renal graft failure. Keeping failed kidney transplants in situ with concomitant minimization or withdrawal of immunosuppression is standard of care in many transplant centers. It is unclear, however, whether the resulting allospecific immune response can cause a microinflammatory milieu. The present work investigated the impact of allograft nephrectomy on systemic inflammation, erythropoiesis, and donor-specific antibodies (DSA).
We performed a retrospective analysis evaluating C-reactive protein (CRP), hemoglobin concentration (Hb), ferritin, iron substitution dosages, erythropoietin dosages, and DSA in 92 transplant recipients with allograft failure, of whom 49 did not (Group A) and 43 did undergo transplant nephrectomy (Group B). Blood samples and clinical data were obtained 3-6 months after returning to dialysis. We additionally assessed outcome of kidney re-transplantation in a 10-year follow-up.
There was no significant difference in Hb concentrations, ferritin concentrations, CRP concentrations, iron, and EPO substitution dosages between the 2 groups. Patients undergoing nephrectomy had a significantly higher prevalence of DSA (65.1% vs 38.8%, P<0.0001). In the 10-year follow-up, 3 patients (12%) of Group B and none in Group A had allograft failure after primary successful re-transplantation.
Keeping a kidney graft in situ after returning to dialysis did not lead to an increase in microinflammation. Although DSA develops in more than 50% of patients after an allograft nephrectomy, the outcome of a renal re-transplantation seems to be unaffected. Thus, both strategies are feasible options in kidney transplant recipients after return to dialysis.

Keywords: Immunization; Inflammation Mediators; Kidney Transplantation


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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358