Pediatric Nephrology

, Volume 31, Issue 12, pp 2235–2247 | Cite as

Kidney retransplantation in children following rejection and recurrent disease

  • Rebecca C. GravesEmail author
  • Richard N. Fine
Educational Review


Retransplantation accounts for approximately 15 % of the annual transplants performed in the USA, and in the recent International Collaborative Transplant Study report on pediatric patients 15.2 % of the 9209 patients included in the report were retransplant recipients. 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. Therefore, it is likely that the majority of pediatric renal allograft recipients will require one or more retransplants during their lifetime. 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 review be taken into consideration during the counseling of families on the optimal approach for their child who requires a retransplant.


Retransplantation Outcomes Graft failure Pediatric Nephrectomy Recurrence Non-adherence Biomarkers 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© IPNA 2016

Authors and Affiliations

  1. 1.Pediatric Residency ProgramLos Angeles County + University of Southern California (LAC+USC) Medical CenterLos AngelesUSA
  2. 2.Department of PediatricsStony Brook University School of MedicineStony BrookUSA
  3. 3.Department of PediatricsKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA

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