A 3RD KIDNEY-TRANSPLANT - COST-EFFECTIVE TREATMENT FOR END-STAGE RENAL-DISEASE

Given the organ donor shortage, some question whether a third kidney t ransplant can be justified. We studied the outcome of 51 third transpl ants (mean age 28+/-2 yr) done between 1 January 1985 and 31 December 1994. We compared hospital stay (mean+/-S.E.), cost, readmissions, rea dmission days, and outcome of third (vs. first and second) transplants . We found that patient survival for third transplants was equivalent to first and second transplants; graft survival was not as good. Howev er, when third transplant recipients with recurrent disease (specifica lly, hemolytic uremic syndrome and focal sclerosis) were excluded from our analysis, we found no difference in 5-yr graft survival (vs. firs t or second transplant recipients). Of the 51 third transplant recipie nts, 41 had a cadaver donor transplant. Third cadaver transplant recip ients tended to have a longer hospital stay (p=NS) than first cadaver transplant recipients but had no more readmissions or readmission days than first or second cadaver transplant recipients. Employment data a re available for 28 third transplant recipients; 16 (57%) are currentl y working or going to school. Of the 21 recipients who responded to qu ality of life questionnaires, 17 (81%) reported being healthy and all 21 (100%) said transplantation was not a drawback to their health. We conclude that third transplants should be considered for selected pati ents with renal failure whose first or second transplants have failed. Such patients can often be successfully transplanted.