Simultaneous Renal Allograft Nephrectomy and Allotransplantation

Retransplantation after failure of the first kidney is now a common occurrence. Usually, nephrectomy is done first and retransplantation is performed later. Hume¹ advises waiting at least 30 to 40 days between removal of the first transplant and placement of the second. However, with increased reliance on leukocyte typing,² a cadaver kidney may become available which matches a patient who is in good clinical condition, but is undergoing either acute or chronic rejection of his homograft. This offers the opportunity for retransplantation at the time of removal of the rejected graft, which spares the patient an additional operation and can provide him with a matched graft. Especially in cases of rare phenotypes, a matched graft might not become available for a long time and, therefore, should be used whenever possible. Recently, we have performed two renal allograft nephrectomies and immediate retransplantation, with good graft survival up to six months.