The third kidney transplant.

To determine the feasibility of third kidney transplantation, the experience at the University of Iowa was evaluated. The success of 14 such transplantations was dependent on the outcome of both of the previous graft operations. Three successful third transplantations with graft survival of 6 years, 3 years, and 1 year have occurred in recipients with more than 1 year survival of a previous kidney. Conversely, graft loss due to rejection developed in all patients who experienced graft survival of less than 1 year for both antecedent grafts. Moreover, HLA-A and -B matching and level of presensitization were not predictive of success in this series. These data suggest that third kidney transplantation using conventional immunosuppression may not be appropriate in the subgroup of patients who have clearly lost their first two grafts to early rejection.