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21 May 2024 : Original article  

[In Press] Long-Term Graft and Patient Survival After Re-Transplantation

Dana Bielopolski ORCID logo12ACDEF, Aviad Gravetz ORCID logo34DE, Timna Agur ORCID logo54E, Renana Yemini ORCID logo2E, Benaya Rozen Zvi ORCID logo54ACDE, Eviatar Nesher ORCID logo64DE

DOI: 10.12659/AOT.943903

Ann Transplant In Press; DOI: 10.12659/AOT.943903  

Available online: 2024-05-21, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Kidney transplant recipients have higher life expectancy but may require subsequent transplantations, raising ethical concerns regarding organ allocation. We assessed the safety of multiple kidney transplants through long-term follow-up.
A retrospective cohort study was conducted at a single center, categorizing patients based on the number of kidney transplantations received. The primary outcome was the composite of death-censored graft failure and overall mortality. The secondary outcome was death-censored graft failure.
Between 2000 and 2019, our center performed 2152 kidney transplantations. Patients were divided into 3 groups: A (1 transplant; n=1850), B (2 transplants; n=285), and C (3 or more transplants; n=75). Group C patients were younger, had fewer comorbidities, and received more aggressive induction therapy. The primary outcomes, including death-censored graft loss and overall mortality, showed similar rates across groups (A: 21.3%, B: 25.2%, C: 21.7%, p=0.068). However, the secondary outcome of death-censored graft failure alone was significantly lower in group A compared to the other groups. No significant difference was observed between groups B and C (8% vs 16% and 13%, respectively, p=0.001, p=0.845). Multivariate analysis identified having a living donor as the strongest predictor of patient and graft survival in all study groups.
Graft and patient survival rates were similar between first and multiple transplant recipients. Multiple transplant recipients had lower death-censored graft failure risk compared to first transplant recipients. However, the risk did not differ among second and subsequent transplant recipients. Younger patients, especially those with a living donor, should be considered for repeat kidney transplantation.

Keywords: Kidney Transplantation; Multiple Transplantations; Immunosuppression; Living Donor; Kidney Graft

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358