Outcome of Patients after Third and Fourth Kidney Transplantation

Abstract

Introduction: A debate exists whether patients after second graft loss should be considered for a third and subsequent graft. Hence, a retrospective analysis was undertaken to assess outcomes of patients who underwent third and fourth transplantation. Materials and Methods: A total number of 16 kidney transplantations, were included in the present study. Thirteen patients out of them underwent a third kidney transplantation and 3 were fourth graft recipients. Data and variables on patient and graft survival were retrieved and analyzed using Kaplan-Meier statistics. Postoperative complications were assessed and graded based on Clavien-Dindo classification. Results: Patient survival was 92.3% after 1 year and 76.9% after 5 years (third graft). One year censored graft survival was 100% and a 5-year graft survival was 74.1% (third graft), respectively. In the cases of fourth transplantation, graft survivals of 33.3% at 1 and 2 years were noted among 3 patients. All fourth graft recipients have survived during our observation time. The overall rate of postoperative surgical complications among third graft recipients was 46.2 and 66.7% among patients after fourth transplantation. Conclusions: Results on third kidney transplantation showed satisfactory patient and graft survival with acceptable outcome.

Outcomes of first versus third kidney transplantations: propensity score matching and paired subgroup analysis—a single-centre experience

“…Our finding corresponds to the multicentre ET study [ 14 ]. Many other groups reported similar patient survival as compared to first and second transplants, but the leading causes of death, cardiovascular events and sepsis, correlate with our findings [ 3 , 10 , 12 , 13 , 24 , 25 , 44 ].…”

“…Reported results of third transplantations are a bit inconsistent. Some studies demonstrated a similar survival rate to that of primary transplants, at least for patient survival [ 10 , 12 , 13 ]. However, the majority of the literature agrees on inferior graft survival with a higher complication rate [ 11 , 14 – 16 ].…”

Patterns of Early Rejection in Renal Retransplantation: A Single-Center Experience

“…Renal retransplant patients had high rates of acute rejection, from 33% to 69%, as reported in previous studies [4–6]. About two-thirds of these rejections were verified as antibody-mediated rejection (ABMR), comprising the primary cause of early graft loss.…”

Comparing outcomes of third and fourth kidney transplantation in older and younger patients

“…This combined with the immunologic barriers due to sensitization from previous grafts results in higher rates of post‐operative complications following a third or fourth KT (3KT or 4KT) 1–11 . However, survival benefit to 3KT has been demonstrated, and single centers have reported positive experiences with 4KT, although the cohorts have been ≤15 recipients 1–6,8–16 . Recently, a registry analysis reported that graft and patient survival of 4KTs were comparable to 3KTs, and the number of these transplants has increased over the past three decades 17 …”

“…[1][2][3][4][5][6][7][8][9][10][11] However, survival benefit to 3KT has been demonstrated, and single centers have reported positive experiences with 4KT, although the cohorts have been ≤15 recipients. [1][2][3][4][5][6][8][9][10][11][12][13][14][15][16] Recently, a registry analysis reported that graft and patient survival of 4KTs were comparable to 3KTs, and the number of these transplants has increased over the past three decades. 17 However, the mean or median recipient age in the above-cited studies was 32-48 years and none have specifically looked at older adults (≥65 years of age).…”