Background: Kidney retransplantation has emerged as a crucial treatment approach as the number of patients experiencing graft failure increases. However, evidence regarding long-term outcomes remains scarce in developing countries due to multiple barriers.
Methods: This single-center retrospective study included 43 second kidney transplant recipients who were transplanted between January 1993 and April 2023 and 120 matched first transplant recipients based on recipient age and sex, donor age and sex, donor type, HLA-A, HLA-B, and HLA-DR mismatch number, and transplantation year. Recipient-donor characteristics, post-transplant outcomes, death-censored graft and patient survival were evaluated.
Results: The mean age of the study population (n = 163) was 40.75 ± 10.96 years, with male predominance (57.6%). 24% of grafts were received from deceased donors. The retransplantation group demonstrated higher rates of flow cytometry cross-match B lymphocyte positivity, desensitization, and induction therapy, despite similar numbers of HLA mismatches and donor-specific antibody positivity when compared to first-time transplant recipients. No differences were observed between the groups regarding kidney function or acute rejection rates during the follow-up period. Death-censored graft survival and patient survival rates at 3, 5, and 10-years were 94.3%, 88.0%, 66.7% and 100.0%, 100.0%, 66.7% for the retransplantation group, compared to 98.1%, 87.9%, 57.6% and 100.0%, 93.5%, and 82.4% for the first transplantation group, respectively. Previous transplantation was not a risk factor for graft or patient loss (p = 0.554 and p = 0.588, respectively). Increased recipient age (HR = 0.984, 95%CI = 0.969-1.000, p = 0.049) and elevated donor eGFR (HR = 0.902, 95%CI = 0.840–0.968, p = 0.004) were associated with better death-censored graft survival, while increased recipient age (HR = 1.055, 95% CI = 1.035–1.076, p < 0.001) and deceased donor (HR = 2.176, 95% CI = 1.286–3.682, p = 0.004) were independent risk factors for patient loss.
Conclusion: Kidney transplantation after graft loss demonstrated comparable short and long-term graft and patient survival outcomes to the first transplants in Türkiye. Kidney retransplantation has the potential to improve long-term patient outcomes in developing countries, after addressing economic and medical barriers, and regional disparities in healthcare access.
Keywords: Kidney transplantation; Retransplantation; Survival.