Outcomes of pediatric kidney re-transplantation: a single-center cohort study

Children with end-stage renal disease (ESRD) frequently require more than one kidney transplantation (KT) during their lifetime due to limited graft longevity. Despite this clinical reality, few studies have evaluated long-term outcomes following repeat pediatric KT. We conducted a retrospective single-center study analyzing 120 KTs performed in 89 pediatric recipients between 1993 and 2024. Outcomes included graft function, postoperative complications, and long-term graft and patient survival. Recipients were stratified into primary (1KT), second (2KT), and third (3KT) transplantation groups. At the time of 1KT, median recipient age was 11.0 years (IQR 7.0, 14.5). Living donation accounted for 16.7% of procedures. Graft failure within five years occurred in approximately 20% of 1KT cases. Half of these patients received a 2KT after a median waiting time of 4.6 years (IQR 2.1, 9.0). Rates of early postoperative complications and kidney function were comparable across groups. Kaplan-Meier analysis revealed significantly improved long-term survival following 2KT compared to failed 1KT (p = 0.023). Repeat kidney transplantation is a feasible and effective strategy for pediatric ESRD patients. Second transplants provide long-term outcomes comparable to, or better than, initial grafts. Multicenter prospective studies are warranted to confirm these findings.