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Updated: Jul 2, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
Kidney Retransplantation in Children
1From the Farah Association for Child with Kidney Disease, Damascus, Syria.
Insights
Most pediatric kidney transplant recipients need retransplants due to suboptimal long-term function. Subsequent pediatric kidney retransplants have lower survival rates than initial transplants, necessitating careful consideration of prior graft failure causes.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Surgery
Background:
- Pediatric kidney transplant recipients frequently require retransplantation due to suboptimal long-term allograft function, despite advances in immunosuppression.
- A significant percentage of deceased donor waitlist patients, particularly in the US (15% of annual transplants), are awaiting retransplantation.
- Second and subsequent pediatric kidney grafts exhibit inferior long-term survival rates compared to initial grafts, with outcomes worsening with each successive transplant.
Purpose of the Study:
- To review the factors influencing the outcomes of pediatric kidney retransplantation.
- To highlight the challenges and considerations in managing pediatric patients requiring repeat kidney transplants.
- To inform family counseling regarding the optimal approach for children needing retransplantation.
Main Methods:
- Review of current clinical management and outcomes in pediatric kidney retransplantation.
- Analysis of factors affecting long-term graft survival in repeat pediatric transplants.
- Discussion of ethical considerations and pre-transplant management strategies.
Main Results:
- Long-term allograft function in pediatric kidney transplant recipients remains suboptimal, increasing the likelihood of retransplantation.
- The primary determinant of retransplant success is the cause of the previous graft failure.
- Nonadherence-associated graft loss presents ethical challenges impacting retransplant eligibility.
- The impact of in situ failed grafts on panel reactive antibodies requires further investigation.
Conclusions:
- Pediatric kidney retransplantation is a common necessity, but long-term outcomes are poorer than initial transplants.
- Understanding the reasons for prior graft failure is critical for successful retransplantation.
- Careful patient selection, management of pre-transplant factors, and family counseling are essential for optimizing pediatric kidney retransplant outcomes.
Abstract:
Pediatric kidney transplant recipients will likely require a retransplant in their lifetime. Although the significant advances in clinical management and newer immunosuppressive agents have had a significant effect to improve short-term allograft function, it is apparent that long-term allograft function remains suboptimal. Therefore, it is likely that most pediatric renal allograft recipients will require 1 or more retransplants during their lifetime. In the West, an increasing number of patients on the deceased donor wait list are awaiting a retransplant; in the US, 15% of current annual transplants are retransplants. Unfortunately, the use of a second or subsequent grafts in pediatric recipients has inferior long-term graft survival rates compared with initial grafts, with decreasing rates with each subsequent graft. Multiple issues influence the outcome of retransplant, with the most significant being the cause of the prior transplant failure. Nonadherenceassociated graft loss poses unresolved ethical issues that may affect a patient's access to retransplant. Graft nephrectomy prior to retransplant may benefit selected patients, but the effect of an in situ failed graft on the development of panel reactive antibodies remains to be definitively determined. It is important that these and other factors discussed in this presentation be taken into consideration during the counseling of families on the optimal approach for their child who requires a retransplant.
