Aspectos quirúrgicos en los terceros y cuartos retrasplantes renales

introduction and objectives: a quarter of patients waiting for kidney transplantation are patients with previous graft failure. outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. we revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome. material and method: 1364 renal transplants have been carried out in our centre since 1975 until december 2003. we have retrospectively revised the 34 patients with three renal transplants and the 5 with four. we analyse the surgical technique, surgical complications and graft outcome. results: mean age was 42 years (21-65). average mismatches between donor and recipient was 3.2. all kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days-17.5 years). all implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). mean average duration of the procedure was 166 minutes (100-300). nephrectomy of previous graft at the moment of the implant was carried out in 13 patients (33%). vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way. ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. we had an abscess secondary to intestinal fistulae. other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservati