Trends and Outcomes in Kidney Retransplantation: A Two-Decade Longitudinal Analysis

Purpose: We aimed to evaluate kidney retransplantation outcomes to optimize patient care and reduce the risk of further retransplantation. Methods: We conducted a retrospective longitudinal analysis of the SRTR database for kidney retransplants performed in the United States from January 2000 to May 2023. Patients were divided into subgroups based on transplant date and number of previous transplants. Outcomes were assessed by patient and allograft survival. Results: A total of 34,230 patients were evaluated (12,224 in 2001–2011, 22,006 in 2012–2023). The proportion of DCD donors was significantly higher in 2012–2023 (21.3% vs. 8.8%, p < 0.001). Both patient and allograft survival improved in the more recent time frame (5-year survival: 84.8% vs. 83.7% for patients; 75.9% vs. 69.3% for allografts, p < 0.001). Allograft failure rates were higher with increasing retransplant attempts (5-year survival: 73.4% vs. 71.8% vs. 62.3% for first, second, and third+ retransplants, p < 0.001). DGF increased failure risk (HR: 1.69 [1.60–1.79] in 2000–2011; HR: 1.79 [1.63–1.97] in 2012–2023), as did higher KDPI (HR: 1.96 [1.70–2.26] in 2000–2011; HR: 2.34 [1.82–3.01] in 2012–2023). Allograft thrombosis contribution as an etiology for failure increased (OR: 2.94 [2.20, 3.92] for the first; OR: 3.13 [1.58, 6.79] for the second+ retransplants). Conclusion: Kidney retransplant outcomes have improved, but each successive transplant has a poorer prognosis. Careful patient selection and risk assessment, especially regarding high KDPI and DGF, are critical. Further investigation is needed into the rising proportion of allograft thrombosis.