Intro:Pediatric kidney transplant (KTx) recipients with early first kidney graft loss(within 30 days) may have graft failure from technical complications or patient disease(hypercoagulability, acute rejection, disease recurrence).These issues raise concerns regarding second attempts at transplantation.We examined the association between short early graft survival in pediatric patients and second KTx graft survival.Methods:Retrospective study of UNOS database 1988-2009 to assess graft survival of first and second KTx in patients with early first KTx graft failure(<30days) who underwent first KTx at age<18 years old. Graft survival analysis was performed by Kaplan-Meier statistics and log-rank tests. Results:Second KTxgraft survival of 300 patients with early first KTxgraft loss was superior with median survival time of 9.0 years(IQR 3.4-18.1) compared to other groups with longer first graft survival.

The most common causes of first graft failure were graft thrombosis/complication(51.5%) and hyperacute/acute rejection(19.7%).The most common cause of second graft failure was chronic rejection(29.3%), while failure due to graft thrombosis/complication was lower(12.9%).Of note, 14.7% of patients had graft loss within the first post-transplant year due to graft thrombosis/complication(5.0%) and hyperacute/acute rejection(4.6%). Despite this, second kidney graft survival for patients with <30-day first graft survival time was comparable to patients with >5 years of first kidney survival.Conclusion:Although pediatric patients with early first graft loss of <30days have a high degree of technical/unexpected complications, it does not convey a greater risk of poor second graft outcomes, making this group’s second KTx graft survival comparable to other patients with long first graft survival time and superior to those with first graft loss 30days-5years.

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