Introduction: Renal re-transplantation has emerged as an important treatment following failed of primary allograft. However, it raises conflicting results about safety and efficacy.
Method: We conducted a retrospective analysis encompassing kidney re-transplanted recipients between 2009 and 2022 in three referral hospitals. We identified 5 third (male 4, female 1; mean age = 42.4) and 88 second (male 61, female 27; mean age = 39.08) transplantations, compared with 143 (male 90, female 53; mean age = 41.58) randomly selected first transplantations. Data collection included short-term and long-term complications (hematoma, hemorrhage, acute and chronic rejection, mortality, cardiovascular complications, infection rate, and urological disorders), hospitalization durations, demographic characteristics, dialysis, induction treatment, surgical technics, the degree of PRA, and anti-HLA Ab levels.
Result: We did not observe any significant differences between first, second, and third transplantations regarding hospitalization duration, cardiovascular complications, age of transplantation, post-operative blood transfusion, creatinine at discharge, and graft dysfunction concerning mortality and rejection rate. On the other side, it was significant differences with respect to short-term complications (P=.029), long-term complications (P=.027), infection rates in both the short (P=.038) and long term (P=.001), duration of surgery (P=.00), HLA incompatibility (P=.000), increase in PRA levels (P=.000), and induction treatments (P=.006), all of which were more prevalent in re-transplantation cases compared to first transplants.
 Conclusion: The comparison between the first kidney transplantation and re-transplantation has shown acceptable results, but more prospective studies are necessary for considering of each influential factor on graft survival.