WALTHAM, Mass.—A renal allograft was removed from a 27-year-old man on post-transplantation day 14 and donated to a 66-year-old man on the waiting list after the first patient suffered persistent proteinuria, worsening hypoalbuminemia, rising creatinine, and the development of intraabdominal hematoma beginning on posttransplantation day 2.
Both patients and the hospital ethics committee and internal review board consented to the transfer. The allograft, originally donated by the younger man's sister, regained function immediately after retransplantation, with serum creatinine levels declining from 5.27 to 1.84 mg/dL and proteinuria falling from 25 g to 1.2 g per 24 hours, according to a report in the New England Journal of Medicine
Biopsies performed on days 8 and 25 after retransplantation showed a reversal of the histopathologic lesions seen developing in the first recipient. Eight months after retransplantation, the second recipient's glomerular filtration rate remained above 90 mL/min/1.73m2 in the setting of mild proteinuria (0.27 g per 24 hours).