Organ retransplantation in the United States: trends and implications

Although the aggregate proportions of patients listed for and receiving a retransplant have changed little over time in the United States, wide variations in retransplantation rates exist across the various organs. Furthermore, the overall number of repeat transplant candidates has increased dramatically for all organs, as has the number of a second (or higher order) transplants performed. Repeat transplant candidates account for 11% to 13% of all wait-listed candidates for all organs in each year between 1990 and 2007. Repeat transplants represented 12.0% of all transplants in 1990 and 9.5% in 2007. During the same period, the number of repeat transplant candidates increased from 2,322 to 4,553 for kidney, 16 to 122 for lung, 417 to 831 for liver, and 119 to 169 for heart. Similarly, the number of repeat transplants increased from 1,293 to 1,867 for kidney, 9 to 83 for lung, 403 to 487 for liver, and 55 to 97 for heart. The rate of allograft survival was almost uniformly superior for first transplants compared with repeat transplants, with the exception of deceased donor kidney transplantation, for which the unadjusted 5-year allograft survival rate was similar for first and second transplants (70% vs. 69%, p = 0.5).