*Purpose: The number of patients relisted for repeat kidney transplantation is increasing due to prolonged survival after first transplantation. This study is designed to compare the outcomes of second living donor kidney transplantation (LDKT) with first LDKT.

*Methods: Data were collected retrospectively for 1429 LDKT, performed from 1995 to 2020 at Samsung Medical Center. Demographic data of recipients and donors, immunologic factors, and outcomes of 2nd LDKT were compared to those of 1st LDKT.

*Results: Among 1429 cases of LDKT, 1355 were 1st LDKT, and 74 were 2nd LDKT. Basic demographic data were comparable for these two groups of patients.(Table 1) The 5- and 10-year graft survival of 1st LDKT were 94% and 84%, respectively, while those of 2nd LDKT were 96% and 86%, showing no significant differences (P = 0.399).(Figure 1) The 5-year patient survival of 1st LDKT was 98% and that of 2nd LDKT was 96%, while the respective 10-year survival was 94% and 93%, showing no significant differences (P = 0.766).(Figure 2) Multivariate analysis confirmed that history of previous transplantation was not a risk factor of graft survival (HR 0.83, P = 0.677) or patient survival (HR 1.68, P = 0.396).(Table 2&3)

*Conclusions: Therefore, repeat kidney transplantation with living donor is reasonable treatment of choice for patients experiencing graft loss.

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