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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 impact on improving short-term allograft function, it is apparent that long-term allograft function remains suboptimal.
it is likely that the majority of pediatric renal allograft recipients will require one or more retransplants during their lifetime. In the west, Increasing numbers of patients on the deceased donor wait list are awaiting a retransplant; in the US, 15% of current annual transplants are retransplants.. Unfortunately, a second or subsequent graft in pediatric recipients has inferior long-term graft survival rates compared to initial grafts, with decreasing rates with each subsequent graft. Multiple issues influence the outcome of retransplantation, with the most significant being the cause of the prior transplant failure. Non-adherence-associated graft loss poses unresolved ethical issues that may impact access to retransplantation. Graft nephrectomy prior to retransplantation may benefit selected patients, but the impact 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.
The issues that could potentially influence the outcome of kidney retransplantation are: Etiology of the initial kidney graft failure particularly recurrence, non-adherence, and antibody mediated rejection. Sensitization status with the presence of panel reactive antibodies, donor specific antibodies, graft nephrectomy prior to retransplantation, certain mitigating technical circumstances, and certain ethical concerns.