Intro: Pediatric kidney transplant(KTx) patients with FSGS/SLE/HUS(Focal Segmental Glomerulosclerosis/Lupus/Hemolytic Uremic Syndrome) may experience recurrent disease which negatively impacts graft survival. We examined whether first graft survival time was associated with second KTx graft survival in this population. Methods: Retrospective analysis of the UNOS database 1988-2009 assessed graft survival of first and second KTx in patients with highly recurrent disease who underwent first KTx at age<18 years. Graft survival analysis was performed using Kaplan-Meier statistics, log-rank tests, and Cox modeling. Results: Patients with a pediatric renal disease diagnosis of FSGS/SLE/HUS were analyzed (n=323). Median second KTx graft survival time was 5.9 years with an interquartile range(IQR) of 2.5-13.1 years. Common causes of first KTx graft failure were chronic rejection (46.9%) and recurrent disease (19.6%). Second KTx graft failure was due to chronic rejection(38.0%), other(20.37%) and recurrent disease(16.7%). Median second KTx graft survival of those with recurrent disease as cause of first KTx failure was 4.0(IQR 1.2-6.5) years. Median second KTx graft survival was worse for patients whose first grafts lasted 30days-1 year and 1-5 years(4.0 and 4.2 years) compared to those lasting 0-30 days and >5 years(9.4 and 8.5 years); p<0.01.

Conclusion: Pediatric patients with potentially recurrent etiologies had inferior transplant outcomes compared to those without such diseases. Within this group, there were significant differences in second KTx graft survival related to first KTx graft survival time. Second graft outcomes as a group were inferior to first graft outcomes for this cohort. Despite high graft quality in the pediatric population, poor outcomes in second transplants in patients with recurrent disease and short first graft outcomes should assist in medical decision making.

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