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Outcomes in Third and Fourth Kidney Transplants Based on the Type of Donor

Dabare, Dilan MRCS1; Kassimatis, Theodoros MD, PhD1; Hodson, James BSc2; Khurram, Muhammad Arslan PhD, MRCS1; Papadakis, Georgios MSc, MBBS1; Rompianesi, Gianluca MD1; Shaw, Olivia PhD3; Karydis, Nikolaos PhD1; Callaghan, Chris PhD, FRCS1; Olsburgh, Jonathon PhD, FRCS1; Mamode, Nizam MD, FRCS1; Kessaris, Nicos FRCS1; Loukopoulos, Ioannis PhD, FRCS1

doi: 10.1097/TP.0000000000002428
Original Clinical Science—General

Background. An increasing number of patients are requiring multiple retransplants. We assessed outcomes of third and fourth kidney transplants, to aid decision making on the most suitable donor type.

Methods. Data were collected retrospectively for 2561 transplants, including 69 third and 8 fourth, performed from 2000 to 2017. Demographics and outcomes for the combined third/fourth group were compared to first and second transplants. Within the third/fourth kidney transplant group, comparisons were made between deceased donors (n = 39), live donor HLA-compatible (n = 23) and -incompatible (n = 13) transplants, as well as between standard (n = 25) and extended-criteria (n = 14) deceased donor transplants.

Results. Patient survival did not differ significantly by transplant number (P = 0.532), whereas death-censored graft survival declined progressively, from 89% at 5 years in first, 85% in second and 74% in the third/fourth transplant group (P < 0.001). Within the combined third/fourth transplant subgroup, 5-year graft survival was found to be 100% in recipients of HLA-compatible live donors, compared to 75% in deceased donors and 53% in HLA-incompatible live donors, although this difference did not reach statistical significance (P = 0.083). No significant difference in patient survival (P = 0.356) or complication rates (P = 0.757) were detected between these groups. For recipients of deceased donors in the third/fourth transplant group, there were no significant differences between standard versus extended-criteria donors for any of the outcomes considered.

Conclusions. Despite variable functional outcomes, third and fourth kidney transplant recipients experience comparable patient survival rates to first and second transplants, regardless of the donor type. In selected patients, HLA-incompatible live donors and extended-criteria deceased donors should be considered.

1 Department of Nephrology and Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, United Kingdom.

2 Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

3 Clinical Transplantation Laboratory, Viapath, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, United Kingdom.

Received 16 October 2017. Revision received 8 August 2018.

Accepted 10 August 2018.

The authors declare no funding or conflicts of interest.

D.D. collected data and wrote the article. T.K. and N.K. participated in the study design and contributed to writing the article. M.K., G.P., G.R., and O.S. participated in the significant contribution to data collection. J.H. participated in the statistical analysis. C.C., J.O., N.M., and N.K. critically revised the article. I.L. participated in the study design, data analysis and writing of the article.

Correspondence: Dilan Dabare, Department of Nephrology and Transplantation, Guy’s Hospital, Great Maze Pond, London, SE19RT, United Kingdom. ( or

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