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Organ Donation and Transplantation - Is it possible to have another transplant if the first one fails?


Key Points

  • Most people can have a second, or even third, transplant
  • The wait for a second transplant is usually longer than for a first transplant
  • The success of a second transplant is, on average, as good as for a first transplant

It is usually possible to have a second kidney if the first one fails. However, there are more ‘hurdles’ to get past before this is possible.

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Why did the first kidney fail, and will failure happen the second time around?

Most causes of transplant failure will not repeat themselves in a second transplant. However, there are a few conditions which make doctors worry about early failure of a second transplant. Some types of kidney disease, which caused the original kidney failure, can come back in a transplant, and if they then cause transplant failure there may be some reluctance to try a second transplant.

If a transplant failed because of blood clots, tests to see if you have a tendency to blood clots may be needed. If the transplant failed because someone did not take their anti-rejection drugs properly, doctors will want to be sure that the reasons for not taking drugs are identified and there is an assurance this will not happen again.

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Is the body fit enough for another transplant?

Sometimes heart disease or other problems have developed since the first transplant operation, which would make a second transplant dangerous. People have to go back to square one in the assessment process for transplantation after transplant failure.

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Can another transplant be found?

There can be a long wait for a second transplant. There are two reasons for this. First, the body may have a powerful memory for the tissue types in the first transplant. Most kidney units will not re-transplant someone with the same tissue types as the first transplant. In other words, you may have to wait longer for a better matched kidney.

Secondly, the failed kidney may have caused the body to produce antibodies against the first kidney. These antibodies are directed against the tissue types of the original kidney, but also often react with a whole range of similar tissue types. That may mean that someone has antibodies which will react with 100% of other peoples kidneys, even if the tissue type match is nearly perfect. These antibodies will cause a positive cross-match test (click here for details of the cross-match) and make transplantation impossible. Doctors have tried to find ways of removing these antibodies, and if someone has someone interested in being a living kidney donor, they should talk to their transplant team about the options, which include looking for an ‘exchange’ transplant to avoid antibody barriers, or having an antibody incompatible transplant in a specialist centre.

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Success rate for second transplants

The good news is that the success rate for second transplants is almost as good as for first transplants, once a suitable kidney has been found.

If a second transplant fails, then a third and even fourth transplant and maybe a fifth can be performed.

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.

NKF Controlled Document No. 273: Is it possible to have another transplant if the first one fails? written: 01/05/2000 last reviewed: 22/02/2019