Outcome of Third Renal Allograft Retransplants Versus Primary Transplants from Paired Donors

Abstract

We conclude that third renal transplantation should not be discouraged based on functional outcomes alone.

Kidney retransplantation from HLA‐incompatible living donors: A single‐center study of 3rd/4th transplants

“…Graft survival for 3rd/4th transplants in this study was 95% at 5 years compared with 83.1% in primary transplants and 85.6% for secondary transplants ( P = .35). This compares favorably with other studies which report 5‐year graft survival in three or more transplants of 42.9%‐78.1%, although many of these have a high number of deceased rather than living donors . As with other studies, the majority of graft loss was caused by rejection (5 of the 6), with one caused by early renal artery thrombosis; 50% of these graft losses required graft nephrectomy.…”

“…This compares favorably with other studies which report 5-year graft survival in three or more transplants of 42.9%-78.1%, although many of these have a high number of deceased rather than living donors. 7,[11][12][13]15,23,[26][27][28] As with other studies, the majority of graft loss was caused by rejection (5 of the 6), with one caused by early renal artery thrombosis; 50% of these graft losses required graft nephrectomy. Rejection-free survival was much lower with 59.6%/43.3%/67% of 1st/2nd/3rd and 4th transplants remaining rejection-free at 5 years (no statistical difference between groups).…”

“…[7][8][9][10][11] Data for surgical and graft outcomes in 3rd and 4th renal transplants are limited, with most published series suggesting a significantly greater incidence of surgical, immunological, and infectious complications. 7,[11][12][13][14][15] This frequently translates into significantly poorer graft survival when compared with 1st or 2nd kidney transplants. Nevertheless, 3rd and 4th kidney transplants still confer a significant survival benefit over remaining on dialysis.…”

Single-center experience with third and fourth kidney transplants

“…Nevertheless, the expected survival benefit has to be balanced against an increased risk for infectious complications and malignancies because of long‐term immunosuppression that is necessarily more powerful in multiple transplant recipients because of the sensitization acquired through previous transplants. However, data on patient and graft survival after third and fourth kidney transplantation are scarce [6–17].…”

Campath induction is associated with equalization of short term outcomes in renal retransplantion (but long-term outcomes are worse)

“…Retransplantation remains the most effective treatment of end stage renal disease for those who have experienced the loss of an initial graft [11,17,18]. The percentage of retransplants performed has increased to 15% in 2016 [19].…”