Graft and Patient-Associated Outcomes for Deceased Donor Kidney Transplant as a Re-Transplant: A Ten-Year Experience from a Tertiary Care Center

Abstract

Aims: The high prevalence of End-Stage Renal Disease (ESRD) has led to a shortage of donor kidneys especially for patients who have failed first kidney transplant. However, Deceased Donor Kidney Transplant (DDKT) as a Re-transplant can be a likely option for these individuals. This study aims to evaluate the graft and patient-associated outcomes for DDKT performed as re-transplant over ten years at a tertiary care center. Methods: A retrospective analysis was conducted involving patients (n = 21) who underwent DDKT as a re-transplant between 1st June 2014 and 31st December 2023, with a follow-up till 31st December 2024. Follow-up periods ranged from 12 to 126 months. The demographic and clinical data regarding the recipient, deceased donor, intraoperative course and immunosuppressives as induction and maintenance, were collected and clinical outcomes including renal function, graft rejection, graft failure and all-cause mortality were analyzed. Relevant statistical formulas were implemented on the results to assess their significance and to formulate a conclusion. Results: We noted graft rejection, graft failure, and all-cause mortality in 14.2%, 8.53%, and 14.2% patients respectively. The mean serum creatinine at 5-year follow-up was 103.8 ± 37. Mean anastomosis time and cold ischemia time were 43.7 minutes and 12.9 hours respectively. 81% (n = 17) of the deceased donors were from Standard Donor Criteria (SDC). 19% (n = 4) of patients had DGF. The association of recipient age, gender, comorbidities, donor age, SDC vs Extended Donor Criteria (EDC), and cold ischemia time with studied outcomes was not statistically significant. Conclusion: We observed a relatively low incidence of graft rejections and graft failure in our patients. The findings suggest that with appropriate management, re-transplantation as DDKT can provide satisfactory graft and patient outcomes. Further studies with larger sample sizes and longer follow-up periods are recommended to validate these results and improve patient care strategies.