Introduction: Nephrectomy is usually specified after the loss of a graft when there are signs of intolerance or resistance to erythropoietin. However, the influence of the first graft nephrectomy in the evolution of the second graft is less known. Materials and methods: We conducted a multicenter study of all second transplants performed between January 2001 and December 2005 in 15 centers in our country. Were analyzed: Data from the first graft (donor and recipient age, pretransplant antibody(Ac) titres, rejection acute rate, acute tubular necrosis(ATN), immunosupression, causes of graft loss) Indication of nephrectomy, second transplant data (pretransplant Ac title, acute rejection rate, inmunospresión, ATN, yearly development of proteinuria and renal function and patient and graft survival. The minimum follow-up period is 5 years Results: The sample consists of 525 patients who received a second kidney transplant, 243 had been nephrectomized, in 25 had been performed an embolization and 258 continued with the first graft. The indication for nephrectomy/embolization was 31.5% for graft intolerance in 38.16% by early nephrectomy and required rest from other causes.No nephrectomy for resistance to erythropoietin were made. In the first graft did not find significant differences in donor age, the title of Ac at transplantation, acute rejection rate or frequency of ATN among patients with or without nephrectomy. The duration of first graft was 31.8 months in patients nephrectomized and 94.9 in which nephrectomy was not required. The waiting time for the second transplant was higher in patients nephrectomized (33 vs 23 months, p< 0,01) In the second graft did not find significant differences in donor age, cause of donor death, recipient age or number of HLA incompatibilities in patients with or without prior nephrectomy. The nephrectomized patients had a significantly higher second pretransplant Ac (15.7 vs. 11.8%, p < 0.001), increased frequency of NTA (54% vs. 39%, p < 0.001) and higher rate of acute rejection (24, 7 vs. 17.1%, p < 0.001), as well as more frequently required the use of induction therapy (55 vs 41%, p < 0.01). There were no significant differences in patient survival or graft survival after 5 years of follow-up Conclusions: Nephrectomy was performed in 50.9% of grafts lost. It is indicated by early nephrectomy and graft intolerance syndrome. It is associated with: Increased waiting on dialysis, increased pre-second transplant antibodies, more NTA, more acute rejection, further immunosuppression. No impact on graft and patient survival was observed at 5 years of follow-up.

To the Editor: We have read the article by Touzot et al. (1Touzot M Pillebout E Matignon M et al.Renal transplantation in HIV-infected patients: The Paris experience.Am J Transplant. 2010; 10: 1-7Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar) with great interest. They present the results of a study on kidney transplantation in HIV-infected patients in France. The authors state in the Discussion section that, to their knowledge, their study is the first one describing a European cohort of HIV-positive kidney transplant recipients. However, in 2006, we published an initial study that analyzed the outcomes of all the HIV-infected patients who had undergone kidney transplantation in the high-activity antiretroviral therapy era in another European country, Spain (2Mazuecos A Pascual J Gomez E et al.Renal transplantation in HIV-infected patients in Spain.Nefrologia. 2006; 26: 113-120PubMed Google Scholar). Recently, and almost simultaneously with Touzot et al., we have also reported the results of a case-control study that is an extension of our previous study (3Mazuecos A Fernandez A Andres A et al.HIV infection and renal transplantation.Nephrol Dial Transplant. 2010; (doi: 10.1093/ndt/gfq592.)PubMed Google Scholar). In this recent paper, we compare 20 HIV-positive renal transplant patients with a matched cohort of 40 HIV-negative recipients who received a kidney graft in our country. Almost all the reported experience on this topic comes from the Unites States (4Kumar MSA Sierka DR Damask AM et al.Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients.Kidney Int. 2005; 67: 1622-1629Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar,5Stock PG Barin B Murphy B et al.Outcomes of kidney transplantation in HIV-infected recipients.N Engl J Med. 2010; 363: 2004-2014Crossref PubMed Scopus (376) Google Scholar). In Spain, the HIV-positive transplant patients present some epidemiological characteristics, which could influence their posttransplant outcome. In the American and French studies, the majority of patients are Afro-American or African recipients, whereas almost all of our patients are Caucasian. Among our patients, HCV coinfection is very prevalent because drug addiction background is frequent. However, in spite of these differences, the results have been similar to those reported in the USA: 1-year graft-survival rates were 85% in the Spanish study (2Mazuecos A Pascual J Gomez E et al.Renal transplantation in HIV-infected patients in Spain.Nefrologia. 2006; 26: 113-120PubMed Google Scholar) and 90.4% and 75% in the two most relevant American studies (4Kumar MSA Sierka DR Damask AM et al.Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients.Kidney Int. 2005; 67: 1622-1629Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar,5Stock PG Barin B Murphy B et al.Outcomes of kidney transplantation in HIV-infected recipients.N Engl J Med. 2010; 363: 2004-2014Crossref PubMed Scopus (376) Google Scholar) (median follow-up: 36.2, 19.2 and 20.4 months, respectively). The GFR were also similar [at 1 year: 54 mL/min, Spanish study; 55 mL/min, Kumar et al. (4Kumar MSA Sierka DR Damask AM et al.Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients.Kidney Int. 2005; 67: 1622-1629Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar); 51.8 or 60.5 mL/min in recipients with or without rejection, Stock et al. (5Stock PG Barin B Murphy B et al.Outcomes of kidney transplantation in HIV-infected recipients.N Engl J Med. 2010; 363: 2004-2014Crossref PubMed Scopus (376) Google Scholar)]. In our experience, as in many of the large American studies, the incidence of acute rejection has been high [40%, Spanish study; 29%, Kumar et al. (4Kumar MSA Sierka DR Damask AM et al.Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients.Kidney Int. 2005; 67: 1622-1629Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar); 41%, Stock et al. (5Stock PG Barin B Murphy B et al.Outcomes of kidney transplantation in HIV-infected recipients.N Engl J Med. 2010; 363: 2004-2014Crossref PubMed Scopus (376) Google Scholar)]. In contrast, the rejection rate in the French study is low (15%). Almost all our patients were treated with tacrolimus but only 35% of them received induction therapy. We agree with those authors that these different rejection rates could be due to changes in the immunosuppressive regimens, among other causes. We have also observed that graft survival was worse in our experience in HIV–HCV coinfected patients. However, in our study, graft survival was similar in HIV-positive and HIV-negative patients when we exclude from both groups the patients with HCV infection (1-year graft-survival: 100% in HIV-positive, 96.8% in HIV-negative recipients). The higher prevalence of HIV–HCV coinfection among our patients (40%, Spanish study; 19%, Stock et al. (5Stock PG Barin B Murphy B et al.Outcomes of kidney transplantation in HIV-infected recipients.N Engl J Med. 2010; 363: 2004-2014Crossref PubMed Scopus (376) Google Scholar); 7%, Touzot et al. (1Touzot M Pillebout E Matignon M et al.Renal transplantation in HIV-infected patients: The Paris experience.Am J Transplant. 2010; 10: 1-7Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar) could also explain the differences observed in the results between the different studies. The good results in a large number of studies indicate that the kidney transplantation is a suitable treatment for HIV-infected patients. The long-term follow-up and detailed analysis of particular aspects associated with this population (rejection, HIV–HCV coinfection and others) should continue to be a principal focus of research. The authors of this manuscript have no conflicts of interest to disclose as described the American Journal of Transplantation.

Mazuecos, A.; Marcén, R.; Andrés, A.; Gómez, E.; Zárraga, S.; Burgos, D.; Jiménez, C.; Paul, J.; Rodríguez-Benot, A.; Fernández, C. Author Information