Objectives and Aim: Despite improving graft outcomes over the years, patients with kidney graft loss have a chance of re-transplantation which often provides the best chance for survival and good health. However, graft survival rates following re-transplantation have improved substantially in recent years. Moreover, it has been reported that the long-term survival of second transplants may be similar to that of primary transplants. Reports of re-transplantation outcomes are scarce especially in the middle east region so, we had to present our experience with second renal transplantation in Kuwait.
Patients and Methods: Data of kidney re-transplant recipients - who are followed up in Hamed Al-Essa organ transplant center of Kuwait- performed at our hospital between 1980 and 2018 were retrospectively analyzed. Between the 3038 kidney transplants (KT), 198 were kidney re-transplants (6.51%). The number of KTs from living (related or unrelated) donors was 150; from deceased donors, 48 and 3rd transplants represented 15 cases. We compared 2 groups of patients according to their donor, those with living donors represented group 1 and those with deceased donor represented group 2.
Results: We observed that episodes of acute antibody-mediated rejection (8 cases, 16.6% in group 2 vs. 9 cases, 18.7% in group 1respectively) and T-cell mediated rejection (15 cases, 10% in group 2 vs. 14 cases, 9.33 % in group 1 respectively) were more frequent among patients in group 2 but this did not rank to significance. Concerning 2nd graft outcome, we observed that the percentage of patients with failed grafts was significantly higher in group 2 (p=0.023) while the two groups were comparable regarding the patient outcome.
Conclusion: Both cadaveric and living donor renal allotransplant carry the same risk for graft rejection either AMR or ACR. Meanwhile, the recipients received their kidneys from deceased donors had experienced fewer graft survivals, the patients’ outcome were comparable.