Improved results of multiple renal transplantation in children

The results of 289 renal transplants in 223 children performed at the University of Minnesota during a 15-year period (1968 to 1982) were analyzed retrospectively. We found no statistically significant difference in graft and patient survival rates between 223 first, 50 second, and 13 third transplants. Children with > 1 year primary graft function had a significantly better second graft survival, especially when transplant nephrectomy was unnecessary before retransplantation. Children with < 1 year primary graft function had a poorer second graft survival, particularly when the interval between transplants was < 1 year. To determine the current risk-benefit factors in retransplantation in children, we compared two eras, our recent 7-year experience with our earlier 8-year experience. First graft survival remained essentially unchanged in both eras; however, graft survival rates of second transplants significantly improved, from 58% to 77% at 2 years (p < 0.04). Two-year graft survival rates for nonidentical related kidneys improved from 73% to 82% and for cadaveric kidneys from 30% to 66%. Two-year graft survival rates for human leukocyte antigen (HLA)-identical kidneys were 100% in both eras. Better experience in patient care, abandonment of the practice of early retransplantation in children with rapid loss of the primary graft, changes in blood transfusion policy, and the use of better matched cadaveric kidneys probably account for our improved results. In conclusion, current risk-benefits for first and second transplants in children are the same. In our view, it is unwarranted to maintain children on open-ended long-term dialysis because the first graft has failed, although a period of maintenance dialysis to allow recovery from the complications of the first graft seems justified.