Living Donor Kidney Transplantation: Comparison of Graft Survival Between First and Second Transplants—A Single-Center Experience

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BACKGROUND: Kidney transplantation is the optimal renal replacement therapy, offering superior survival and quality of life compared with dialysis. Although outcomes after repeat transplantation may be inferior to those of first transplantation, retransplantation provides a survival benefit compared with remaining on dialysis. Living donor kidney transplantation (LDKT) offers advantages such as improved HLA matching and reduced cold ischemia time, potentially mitigating retransplantation-related risks. METHODS: We performed a retrospective single-center study including all LDKT performed at ULS Coimbra between 2009-2020, with a mean follow-up of 9 years. Clinical and immunological donor-recipient variables were collected. Death-censored graft survival was assessed using Kaplan-Meier analysis and univariable Cox regression was used to explore predictors of graft loss. Acute rejection was defined according to Banff 2019 criteria. RESULTS: Seventy-six patients were included: 63 underwent a first LDKT and 13 a second LDKT. Baseline characteristics were similar regarding gender, dialysis vintage, HLA mismatches, and cold ischemia time. Second LDKT recipients were older (42 vs 33 years, p = 0.025), had higher historical panel reactive antibody levels, and more frequently received thymoglobulin induction (69.2% vs 16.7%, p < 0.001). Serum creatinine at 1 year was associated with graft loss (p = 0.007). Acute rejection was rare (4% vs 0%). Five- and 10-year death-censored graft survival was comparable between first and second LDKT (88.9% and 87.3% vs 100% and 92.3%, respectively). CONCLUSIONS: Second living donor kidney transplantation achieved excellent long-term graft survival comparable to first transplantation, supporting its safety and efficacy.

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