Background: 15% of our renal transplant program is re-transplantation (Tx2). We aimed to know if Tx2 has a higher risk than first transplantation (Tx1) and if so, to analyze the reason for it.

Methods: We performed a retrospective study by comparing all 162 Tx2 patients transplanted between 2000 and 2009 (study group) and compared them to 162 Tx1 patients matched for age, gender, date of transplantation, and the kind of kidney donation (control group). Primary end-point was graft and patient survival, secondary end-points were clinical parameters with a possible influence on graft and patient survival.

Results: 162 Tx2 patients and 162 matched Tx1 patients were transplanted 2000-2009; both groups had an observation time of 8 to 17 yrs. Graft survival of Tx2 was sign. inferior to that of Tx1 (p=0.0015); while patient survival had a trend (p=0.0633). Group Tx2 had a longer dialysis treatment than Tx1 (113.0±52.5 vs 65.6±33.9 mos; p<0.0001), more HLA mismatches (2.54±1.75 vs 2.08±1.65, p=0.0129) and panel reactive HLA-AB >30% (15.4% vs 1.9%, p=0.0001), more often induction therapy by antithymocyte globuline instead of IL2-R AB (59.9% vs 1.9%, p<0.0001), while basal immunosuppression, cold ischemia time, delayed graft function, s-creatinine post-tx and accompanying diseases were not different. The number of patients with rejection (40.7% vs 36.4%) including humoral rejection (14.8% vs 11.1%) and of rejections per patient (0.59±0.91 vs 0.56±0.87) was not different; however, graft failure by acute and chronic rejection was more frequent in Tx2 patients (43.94% vs 23.73%, p=0.0137). The number of patients with at least 1 severe infection threatening life or graft function was not different between the groups (41.36% vs 39.5%); however, death by infection was more frequent in group Tx2 regarding the entire time of observation (logrank test p=0.0003) as well as during the first 2 months post-tx (logrank test p=0.0168).

Conclusion: Graft failure by rejection was more frequent in group Tx2 than in Tx1 despite a similar number of rejections; that means, that rejections were more severe. And death by infection also occurred more often in Tx2 patients with emphasis on the early post-tx period, despite a similar number of patients with severe infections in both groups. Thus, more severe rejection episodes and a higher infection mortality are important risk factors for an inferior graft survival of Tx2 patients.

CITATION INFORMATION: Schwarz A., Schaefer F., Framke T., Linnenweber S., Haller H. Outcome Analysis of Renal Re-Transplantation Compared to a Matched Control Group of First Transplantation Am J Transplant. 2017;17 (suppl 3).

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