Non-Inferior Outcomes of Third and Fourth Renal Transplant. An Analysis of Our Experience
Transplant Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: B129
Keywords: Highly-sensitized, Kidney transplantation, Survival
Session Information
Session Name: Poster Session B: Kidney Complications: Late Graft Failure
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
INTRODUCTION
Outcome of third and subsequent renal transplants have not been associated with favorable outcomes. We analyze our experience in patients with three or more kidney-transplants focusing on survival and graft outcome.
MATERIAL AND METHOD:
1392 renal-transplants have been carried out at our Centre over last 10 years. N= 37 (31 third; 6 fourth) renal transplants were performed and compared with control group of N= 251 2nd renal transplants during the same period. Standard immunosuppression-protocol was prescribed in either of the groups. Retrospective analysis was done to assess short and long term graft outcomes.
RESULTS:
Mean age was 46 years (22-71 years- 2nd transplant) and 54 years (32-81 years -3rd/4th transplant). Kaplan Meier analysis showed a graft survival of 98%; 93% at 1, 5 years for 2nd transplant recipients compared to a graft survival of 94%; 89% at 1, 5 years for 3rd/4th kidney transplant recipients (p=0.53). The patient survival was 98%; 96% at 1, 5 years for 2nd transplant recipients compared to a patient survival of 97%; 94% at 1, 5 years for 3rd/4th kidney transplants recipients (p=0.29). 
11/251 (4.3%); 6/37 (16.2%) patients were highly sensitized (cPRA >85%) in 2nd and third/fourth transplant groups respectively. Compared to unsensitized recipients, rejection rates were mostly recognized in sensitized recipients; 2nd transplants (OR =0.35, 95% CI 0.003-0.317, p=0.003); 3rd/4th transplants (OR =0.20, 95% CI 0.004-0.118, p=0.006).
Median Operative time for 2nd transplant was 2 hr. 52 min compared to 3 hr. 35 min for third/fourth transplants (p=0.035). On Univariate analysis HLA-DR mismatch (p= 0.04), acute rejection (p= 0.02), prolonged cold ischemia time (p=0.02) and advance donor age (>65 years) (p=0.03) were associated poor graft outcomes in either of the groups.
CONCLUSIONS:
Outcomes of graft and patient survival for 3rd/4th renal transplant are not inferior to 2nd renal transplant. Appropriately chosen donors may alter the outcomes in immunologically disadvantaged 3rd/4th transplant recipients.
To cite this abstract in AMA style:
Sharma H, Yiannollou P, Masood O, Giffruda G, Dhanda R, Dellen DVan, Campbell T, Pararajasingam R, Augustine T, Tavakoli A, Forgacs B. Non-Inferior Outcomes of Third and Fourth Renal Transplant. An Analysis of Our Experience [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/non-inferior-outcomes-of-third-and-fourth-renal-transplant-an-analysis-of-our-experience/. Accessed May 18, 2025.« Back to 2015 American Transplant Congress