Prognosis of renal re-transplantation for chronic graft failure

To analyze the clinical characteristics, patient survival rate, and graft survival rate differences between renal re-transplantation recipients (ReTR) and first-time recipients (FTR) of matched donor kidneys by comparing clinical data, providing evidence for improving graft survival rates in re-transplantation patients.

A retrospective analysis was conducted on renal transplant patients from the Organ Transplant Center of the Northern Theater Command General Hospital between 2020 and 2024. The patients were divided into two groups: the recipient group (ReTR) who received a second kidney transplant and the first recipient group (FTR) who received a matched donor kidney. Clinical data from both groups were collected, and postoperative follow-up was performed.

The group of recipients undergoing renal re-transplantation and the group of initial recipients with matched donor kidneys were each 24 cases. Compared with the initial recipients with matched donor kidneys, the recipients of renal re-transplantation exhibited higher positive rate of population reactive antibodies (PRA) (P = 0.0145) preoperatively, lower platelet and serum albumin levels at 7 days postoperatively, with statistically significant differences (P = 0.006; P = 0.046), and a significant increase in uric acid levels at 14 days postoperatively (P = 0.021); no significant differences were observed in other indicators. There was no significant difference in the incidence of delayed graft function (DGF) between the two groups (45.8% vs. 50%, P = 0.773). Survival analysis results indicated that the graft survival rate of patients undergoing renal re-transplantation was lower than that of patients receiving initial transplantation, with a statistically significant difference (P = 0.022), but no significant difference in survival rates (P = 0.281).Multivariate COX regression analysis results indicated that hypoalbuminemia at 7 days postoperatively was an independent risk factor for mortality in patients after transplantation (HR: 2.387,95.0% CI: 1.072-5.319, P = 0.033). Secondary transplantation (HR: 81.867, 95.0% CI: 1.164-5,758.747, P = 0.042) and postoperative DGF (HR: 156.163, 95.0% CI: 1.249-19,531.98, P = 0.04) were independent risk factors for graft failure.

The graft survival period in patients undergoing repeat renal transplantation is lower than that in first-time renal transplantation, but there is no significant difference in overall survival. Attention should be paid to prevention of postoperative DGF occurrence.Other clinical indicators such as platelet changes, and patients nutritional status should be improved, with a low-purine diet as the mainstay, and uric acid-lowering drugs should be used when necessary.