Outcome Of Renal Transplantation Research Articles

Clinical Perspectives towards Improving Risk Stratification Strategy for Renal Transplantation Outcomes in Indian Patients

Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type – living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification.

300 Indications for and Outcomes of Renal Transplant in Patients With Hereditary Renal Cancer: A Case Series

300 Indications for and Outcomes of Renal Transplant in Patients With Hereditary Renal Cancer: A Case Series

Body Fat Distribution, Adipocytokines Levels and Variability in Associated Genes and Kidney Transplant Outcomes.

Introduction: Body fat distribution is known to contribute to a variety of pathologies. Research Questions: We aimed to assess whether this distribution is associated with clinical outcomes in renal transplant recipients (RTR) and to examine its relationship with leptin and adiponectin gene variants and plasma concentrations. Design: Bioelectrical impedance analyses were performed in 236 RTR. Leptin/adiponectin levels were measured by immunoassay and relevant polymorphisms in the leptin receptor (LEPR) and adiponectin (ADIPOQ) genes were identified. Associations were assessed by logistic regression modeling. Results: The waist-to-height ratio (WHr) displayed a significant association with delayed graft function, acute rejection and post-transplant diabetes mellitus, with OR values of 2.04 (1.02-4.08) p = 0.045; 3.08 (1.22-7.79) p = 0.017 and 2.79 (1.16-6.74) p = 0.022, respectively. Waist circumference was linked to delayed graft function [OR = 1.03 (1.01-1.05), p = 0.025] and AR [OR = 1.041 (1.01-1.07), p = 0.009]. Leptin levels were significantly higher in patients who experienced rejection [19.91 ± 23.72 versus 11.22 ± 16.42 ng/ml; OR = 1.021 (1.01-1.04), p = 0.017]. The ADIPOQ rs1501299TT genotype showed a significant association with higher WHr (0.63 ± 0.11 vs 0.59 ± 0.87 for GG/GT genotypes; p = 0.015) and WC values (102.3 ± 14.12 vs 96.38 ± 14.65 for GG/GT genotypes; p = 0.021). Conclusion: WC, and especially WHr, are associated with adverse outcomes in renal transplantation and are affected by variability in the ADIPOQ gene.

Renal Transplant Experience in a Tertiary Care Center in Saudi Arabia: A Retrospective Cohort Study

Background: Data on outcomes of renal transplantation in the Kingdom of Saudi Arabia (KSA) is limited. We describe renal transplant experience in one of the largest referral centers for renal transplants in KSA.Methods:This is a retrospective cohort study of patients who underwent kidney transplantation at King Abdulaziz Medical City (KAMC) from January 2016 to July 31, 2019, with at least one year of follow-up post-transplantation.Results: One hundred ninety-four individuals were identified and included in the analysis. The mean age of the renal transplant cohort was 45 years with an average pre-transplant body mass index of 26.1 kg/m2. The most common comorbidities were hypertension (77.3%) and diabetes mellitus (34.5%). The most common etiology of end-stage kidney disease (ESKD) was unknown (49.0%) followed by Lupus nephropathy (16.0%). Central venous catheters were the predominant dialysis access (56.2%). Living-related kidney donation was the commonest source of kidney transplantation (61.3%), followed by deceased donor renal transplantation (22.7%). Anti-thymocytes globulin (ATG) was the predominant induction agent (57.7%) and nearly all patients received tacrolimus-based maintenance immunosuppression. Mean serum creatinine at the time of discharge was 109 umol/l. Delayed graft function was observed in 6.7% of our patients. The most common medical complications were urinary tract infection (26.3%). Post-transplant surgical complications occurred at a low rate.Conclusion:Our study demonstrated a successful renal transplant experience among a relatively healthy cohort and identifies potential gaps, particularly the high rate of central venous catheters, the frequent lack of clear etiology of ESKD, the low rate of pre-emptive transplant, and deceased donors. Further studies are needed to evaluate and close these gaps.

Longitudinal monitoring of mRNA levels of regulatory T cell biomarkers by using non-invasive strategies to predict outcome in renal transplantation

BackgroundAcute T-cell mediated rejection (aTCMR) is still an issue in kidney transplantation, for it is associated with chronic rejection, graft loss, and overall worse outcomes. For these reasons, a standard non-invasive molecular tool to detect is desirable to offer a simpler monitoring of kidney transplant recipients (KTRs). The purpose of our study was to examine, in peripheral blood before and after transplantation, the expression patterns of regulatory T cell (Treg)-related genes: the forkhead box P3 (FOXP3) and the two CTLA-4 isoforms (full-length and soluble) to predict acute rejection onset, de novo donor-specific antibodies (DSA) development and renal dysfunction 1 year after transplantation.MethodsWe profiled by using a relative quantification analysis (qRT-PCR) circulating mRNA levels of these biomarkers in peripheral blood of 89 KTRs within the first post-transplant year (at baseline and 15, 60 and 365 days, and when possible at the acute rejection) and compared also the results with 24 healthy controls.ResultsThe three mRNA levels drastically reduced 15 days after transplantation and gradually recovered at 1 year in comparison with baseline, with very low levels at the time of aTCMR for FOXP3 (RQ = 0.445, IQR = 0.086–1.264, p = 0.040), maybe for the pro-apoptotic role of FOXP3 during inflammation. A multivariate Cox regression analysis evidenced a significant relation between aTCMR onset and thymoglobuline induction (HR = 6.749 p = 0.041), everolimus use (HR = 7.017, p = 0.007) and an increased risk from the solCTLA-4 expression at 15 days, mainly considering recipients treated with Mycophelolic acid (HR = 13.94 p = 0.038, 95%CI:1.157–167.87). Besides, solCTLA-4 also predisposed to graft dysfunction (eGFR< 60 mL/min/1.73m2) at 1 year (AOR = 3.683, 95%CI = 1.145–11.845, p = 0.029). On the other hand, pre-transplant solCTLA-4 levels showed a protective association with de novo DSAs development (HR = 0.189, 95%CI = 0.078–0.459, p < 0.001).ConclusionsmRNA levels of Treg-associated genes, mainly for solCTLA-4, in peripheral blood could put forward as candidate non-invasive biomarkers of cellular and humoral alloreactivity in clinical transplantation and might help shape immunosuppression, tailor monitoring and achieve better long-term outcomes of kidney transplantation in the wake of “precision medicine”.

POS-802 RENAL TRANPLANTATION OUTCOMES IN A SINGLE CENTRE SOUTH AFRICAN PRACTICE- A 30 YEAR STUDY -1991 TO 2020

Introduction: Renal transplant is the most enduring outcome especially in a third world setting where dialysis facilities are scanty and socioeconomic challenges are enormous. Previous studies on the outcomes of renal transplantation in the public health sector are scanty and no study in a private practice setting has previously been reported in South Africa.

Does a Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

Does a Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

Outcome of Renal Transplantation in Children Given Rabbit Anti-Thymocyte Globulin (rATG) as Induction Therapy

BackgroundInduction immunosuppressive therapy is used to prevent rejection and maintain allograft function in transplantation. Rabbit antithymocyte globulin (rATG), a T-cell depleting antibody, is the most commonly used induction agent for kidney transplantation. To date there is still limited data on outcomes of pediatric kidney transplants with rATG as induction therapy. MethodsRetrospective single-center study of first-time kidney transplant recipients ≤18 years old who received rATG induction between 2005 and 2019 at the National Kidney and Transplant Institute. Data were collected up to 1 year post transplant. ResultsEleven patients were included in the study. They received rATG at 1.5 mg/kg/dose (±0.3 mg/kg/dose) once a day for 3 days. Patient survival was 100% at 6 months, and 90.9% at 1 year. Graft survival was 90.9% at 6 months, and 81.8% at 1 year. Four patients (36.4%) had a glomerular filtration rate of <60 at 1 year. One died of sepsis at 7 months. One patient (9.1%) had acute allograft rejection with recurrence of disease, C3 glomerulopathy, on day 13. A total of 3 patients (27.3%) developed leukopenia and 4 patients (36.4%) developed thrombocytopenia. The majority were anemic at baseline (9.7 mg/dL), and a significant increase in the mean hemoglobin was seen at 4 weeks (11.6 mg/dL) to 1 year (13 mg/dL). Incidence of recurrent infections was 9.1% (with culture growth) and 36.4% (no culture growth). Hypertension remained unchanged before and after transplant. ConclusionsInduction with single dose rATG at 1.5 mg/kg/dose (±0.3 mg/kg/dose) for 3 days provided effective and safe outcomes in pediatric kidney transplant patients in this study.

Pediatric renal transplantation in Southern Saudi Arabia: A single-center retrospective study

Background: The outcome of pediatric renal transplantation (RT) has improved over the last decades. Aims and Objectives: To study the outcome of pediatric transplantation at our center including patient and graft survival, acute rejection, and surgical complications. Materials and Methods: A retrospective review of pediatric RT outcomes at the only transplant center in Southern Saudi Arabia. Results: between 11/2013 till 03/2020, 63 RT were performed in pediatric recipients 2 through 18 years of age (mean 11.7 ± 3.75) including 43 patients (68.2%) aged 14 and younger. Average BMI-height-age-z were 66.05 ± 6.65 percentile. 49 patients (77.7%) received kidneys from adult living donors (LD), 8(16%) were unrelated donors.41% had preemptive KT. The commonest known etiologies of ESRD were focal segmental glomerulosclerosis, Post Urethral valve, and dysplastic kidney (9.5% each). Thymoglobulin and Basiliximab were used as induction therapy in 37 (58.7%) and 26 (41.3%) patients respectively. With a mean follow-up of 80 months, 1-year and 5-year graft survival rates for LD and deceased donors were (97.2%, 86.4%) and (96.4%, 76%) respectively. 1-year and 5-year patients survival rates were 100%. Conclusions: pediatric renal transplantation outcome at our center, despite the low volume of cases, is encouraging.

From the EDITOR’S DESK

As we begin the year 2022, we, in the young group ‘Women in Nephrology, India’, are filled with a new hope. Hope of a new dawn in the academic horizon, hope of making a new beginning and a new mark in the Nephrology world. We take a new step in this direction by presenting the first issue of our official scientific publication ‘Indian Journal of Kidney Diseases’(IJKD). Although the women nephrologists in India, had the dream of coming together as a group for many years, it attained fruition just about six months back. But it is remarkable that over a short span of six months, the group has made a commendable impact in the academic world. The dynamism of its leaders has taken the shape of a quarterly, open access, journal covering all aspects of Nephrology-General Nephrology, dialysis and transplantation. We aim to provide a platform for the young nephrologists of India and elsewhere to publish their scientific work and shape their academic career. It is my privilege and honor to present the first issue of Indian Journal of Kidney Diseases to the readership. I am grateful to Dr Swarnalatha G for literally taking the publication from the stage of conception to reality, going stage-by-stage through the publication process. Words are not enough to thank the WIN Leads headed by Dr Urmila Anandh and editors, Dr Anita Saxena and Dr Manisha Sahay who guided us at crucial steps. We have a young, enthusiastic editorial team with us to help with the publication. Thanks are also due to the energetic reviewers who helped us with the peer review process and completed the process in very short time periods, varying between two hours and a week. In this issue, we present a variety of clinical materials and I am thankful to each author for the time they have spent on this. Firstly, there is a perspective article from our dynamic leader, Dr Urmila Anandh, regarding her views on the challenges ahead of the women nephrologists and the barriers for their growth. She presents her solutions for enhancing the productivity and mitigation of stress to the women in medicine. Dr Swarnalatha presents the results of a comparative analysis of the outcomes of live donor renal transplants and cadaver renal transplants. Dr Priyamvada and her co-author discuss the nuances of xenotransplantation, which is making the news these days in different parts of the world. There is an interesting case report of recurrent crescentic glomerulonephritis in a young girl. There is also an illustrative image of calciphylaxis. In view of the March month being the Kidney month, on the occasion of the World Kidney Day, there is a topical commentary on the theme of ‘Kidney Health for all’ and its implications for India. As we present this first issue, we are aware of the numerous challenges ahead. We intend to get our journal indexed in some of the prominent indexing sites and for this we need quality publications. Funds are a very prominent challenge. But hope runs eternal and we are hopeful to face the challenges one-by-one and turn them in our favour. In this context, it would serve us well to remember these immortal lines by the ancient Indian poet Kalidasa in ‘Salutations to the dawn’. Look well to this day, For it and it alone is life. In its brief course Lie all the essence of your existence: The Glory of Growth The Satisfaction of Achievement The Splendor of Beauty For yesterday is but a dream, And tomorrow is but a vision. But today well lived makes every yesterday a dream of happiness, And every tomorrow a vision of hope.

Deceased donor renal transplant outcome in a south Indian tertiary care hospital with zonal allocation model - An observational study

Background: With the rising incidence of diabetes and hypertension, the prevalence of end-stage renal disease has increased greatly so as the need for renal replacement therapy. Availability of suitable living-related donors is a major problem which increases the demand for deceased donor renal transplantation (DDRT), making it a lifeline for the patients on dialysis without any living donors. Methodology: This is a retrospective analysis of 118 DDRT done between 2012 and 2020, in a private quaternary care hospital in a south Indian state. All patients received basiliximab induction, with maintenance immunosuppression using steroids, mycophenolate mofetil (MMF) or mycophenolate sodium, and tacrolimus. Results: In our study, we report unadjusted graft survival of 93.2% and 81.3%, patient survival of 94.9% and 83.1% at the end of 1 and 5 years, respectively. The recipients with age < 60 years had 5 years graft survival of 87%. The study group consisted of 15.25% of the patients with panel reactive antibody (PRA) positive and 10.16% of them with donor-specific antibody (DSA) during renal transplantation, and there was only one allograft loss in this subset of the patients. Conclusion: This study confirms that human leukocyte antigen matching is not very important with the current immunosuppressive protocol using tacrolimus and MMF. Early initiations of tacrolimus do not increase the incidence of delayed graft function. We report 91.6% graft survival in the DSA-positive group, with basiliximab induction and desensitization protocol.

Short-term Outcomes of Pediatric Renal Transplantation in Nigeria; A Single-Center Experience :

Introduction This case-series describes a short term follow-up of Renal Transplantation (RT) in three children at the Zenith Medical and Kidney Centre (ZMKC), Abuja, Nigeria. Methods The immediate allograft function (IAF) and recipients’ survival at 6-24 months of follow-up from January 2018 to January 2020 were described. RT involved the use of basiliximab and thymoglobulin for induction therapy and oral prednisolone, tacrolimus and mycophenolate mofetil for maintenance immunosuppressive therapy. Results Recipients were 9 years to 17 years (average age of 12 years) of age. Primary steroid-resistant focal segmental glomerulosclerosis nephrotic syndrome, congenital posterior urethral stricture and lupus nephritis were the causes of the end-stage kidney diseases. The IAF was excellent in all the cases. All the 3 children are alive with good allograft functions at 6-24 months of the follow-up period. Conclusion This case series shows that a successful paediatric RT programme is feasible in a resource-constrained setting like Nigeria

SP5.2.1 Renal Transplant Outcomes Through the COVID-19 Pandemic at a London Transplant Centre

Abstract Aims The aim of this audit was to establish the impact of COVID-19 on the outcomes of renal transplant recipients in the post-transplant period at our centre, through the 2020 calendar year. Methods Living donor and deceased donor renal transplant recipients in the period of interest were identified and any complications or adverse outcomes were reviewed and compared to outcome data from the previous year. Results A total of 88 renal transplants were performed in 2020. Fifty-five cases were performed after reopening the Unit. Five patients tested positive for COVID-19 in the post-transplant period. One patient was admitted to the Intensive Care Unit and subsequently died from related complications. Another patient suffered from internal jugular vein thrombosis shortly after testing positive and could be attributed to the hypercoagulable state post-infection. A total of 4 deaths and 1 graft loss were recorded within 2020. This compares to 1 death, 2 graft losses and 1 primary non-function in 172 transplants in 2019. Of the 4 deaths, one was directly linked to COVID-19. The other 3 deaths could be indirectly linked to the disruptions that were made in the healthcare system during this period in adapting to the pandemic. Conclusions It was anticipated that COVID-19 will directly and indirectly affect patient outcomes from surgery during this period. This was clearly seen at this Unit, with mortality rates having increased almost eight-fold in the post-transplant period compared to the same period in the previous year. However, no significant difference was seen with graft losses.

Proximal Tubule p53 in Cold Storage/Transplantation-Associated Kidney Injury and Renal Graft Dysfunction.

Kidney injury associated with cold storage/transplantation is a primary factor for delayed graft function and poor outcome of renal transplants. p53 contributes to both ischemic and nephrotoxic kidney injury, but its involvement in kidney cold storage/transplantation is unclear. Here, we report that p53 in kidney proximal tubules plays a critical role in cold storage/transplantation kidney injury and inhibition of p53 can effectively improve the histology and function of transplanted kidneys. In a mouse kidney cold storage/transplantation model, we detected p53 accumulation in proximal tubules in a cold storage time-dependent manner, which correlated with tubular injury and cell death. Pifithrin-α, a pharmacologic p53 inhibitor, could reduce acute tubular injury, apoptosis and inflammation at 24 h after cold storage/transplantation. Similar effects were shown by the ablation of p53 from proximal tubule cells. Notably, pifithrin-α also ameliorated kidney injury and improved the function of transplanted kidneys in 6 days when it became the sole life-supporting kidney in recipient mice. in vitro, cold storage followed by rewarming induced cell death in cultured proximal tubule cells, which was accompanied by p53 activation and suppressed by pifithrin-α and dominant-negative p53. Together, these results support a pathogenic role of p53 in cold storage/transplantation kidney injury and demonstrate the therapeutic potential of p53 inhibitors.

Pre-transplant donor-specific HLA antibodies and risk for poor first-year renal transplant outcomes: results from the Swiss Transplant Cohort Study.

The aim of this study was to analyze first year renal outcomes in a nationwide prospective multicenter cohort comprising 2215 renal transplants, with a special emphasis on the presence of pre-transplant donor-specific HLA antibodies (DSA). All transplants had a complete virtual crossmatch and DSA were detected in 19% (411/2215). The investigated composite endpoint was a poor first-year outcome defined as (i) allograft failure or (ii) death or (iii) poor allograft function (eGFR ≤25ml/min/1.73m2 ) at one year. Two hundred and twenty-one (221/2215; 10%) transplants showed a poor first-year outcome. Rejection (24/70; 34%) was the most common reason for graft failure. First-year patient's death was rare (48/2215; 2%). There were no statistically significant differences between DSA-positive and DSA-negative transplants regarding composite and each individual endpoint, as well as reasons for graft failure and death. DSA-positive transplants experienced more frequently rejection episodes, mainly antibody-mediated rejection (both P<0.0001). The combination of DSA and any first year rejection was associated with the overall poorest death-censored allograft survival (P<0.0001). In conclusion, presence of pre-transplant DSA per se does not affect first year outcomes. However, DSA-positive transplants experiencing first year rejection are a high-risk population for poor allograft survival and may benefit from intense clinical surveillance.

A Comparative Analysis of Live-Related ABO-Incompatible and ABO-Compatible Renal Transplantation

Background: ABO incompatible (ABOi) transplantation is a relatively newer option for renal transplant. Despite the encouraging results and the presence of organ shortage, it is still not routine in many developing countries. This can be attributed to the lack of experience, lack of technical infrastructure, and financial limitations. Objectives: Our study aimed to compare the outcomes of living-donor ABOi renal transplantation with matched recipients of ABO-compatible (ABOc) transplantation. We also assessed the impact of Vitamin D deficiency on posttransplant outcomes in terms of graft function and rejections in these groups. Methods: We retrospectively analyzed the results of 33 ABOi living-donor kidney transplants performed between January 2013 and June 2016 at our center. We compared patient and graft survival, acute rejection episodes, Vitamin D status, and graft function of the ABOi group with an equal number of matched live-related ABOc KTs done during the same time period. Results: The patient survival in both the groups was 97%; however, death-censored graft survival was 94% in the ABOi recipients versus 100% in ABOc group over a mean follow-up of 14–15 months, respectively. Graft function was overall better in the ABOc recipients, with statistical significance seen at 6 and 12 months posttransplant. We also observed a significantly higher incidence of acute antibody-mediated rejections (ABMRs) in the ABOi cohort, with 11 episodes of ABMR versus just 2 in the ABOc recipients (P = 0.005). Vitamin D deficiency was associated with higher levels of anti-ABO antibody and increased development of ABMR due to anti-ABO antibodies (P = 0.01). Conclusions: ABO incompatible transplantation is an option with excellent patient and graft survival; results almost comparable to the ABO compatible grafts. However, in our study, ABOi transplants were associated with higher risk of acute ABMR. These episodes were amenable to treatment, and thus, the overall graft survival had similar outcomes. Vitamin D deficiency was associated with increased ABMR in ABOi cohort of renal transplantation.

A Study of Outcomes of Renal Transplantation from Deceased Donors in a Tertiary Care Centre from Southern India

A Study of Outcomes of Renal Transplantation from Deceased Donors in a Tertiary Care Centre from Southern India

A2 to B Deceased Donor Renal Transplantation Outcome Analysis: A Single-Center Experience

A2 to B Deceased Donor Renal Transplantation Outcome Analysis: A Single-Center Experience

Body Mass Index and Kidney Donor Profile Index as Prognostic Markers of the Outcome of Renal Transplantation

The aim of this study was to determine the effects of Kidney Donor Profile Index (KDPI) and body mass index (BMI) of the deceased donor on the kidney allograft outcome 1 year after transplantation. We retrospectively studied 98 deceased kidney allograft donors with a mean age of 56 ± 12 years. The donors were divided into 5 groups according to their BMI: Normal ΒΜΙ=25 (n=25); ΒΜΙ 25 to 29=Overweight (n=33); ΒΜΙ 30 to 34.9=Obese class I (n=19); ΒΜΙ 35 to 39=Obese class ΙΙ (n=11); and ΒΜΙ >40=Obese class III (n=10). We examined the impact of the deceased donor's BMI and KDPI on delayed graft function (DGF) and estimated renal glomerular filtration rate (eGFR) (measured by the Chronic Kidney Disease Epidemiology Collaboration equation) 1 year after transplantation. Donor BMI significantly increased the prevalence of DGF (P=.031), and it was associated with higher cold ischemia time (P=.021). However, there was no significant association between the aforementioned BMI groups and 1-year eGFR (P=0.57), as deceased grafts from donors with increased BMI (BMI > 40) gained sufficient renal function during the first year of transplantation. Moreover, high KDPI was associated not only with DGF (P=.015), but also with decreased values of eGFR (P=.033). In this population, we identified no significant association between donor BMI and long-term clinical outcomes in deceased donor kidney transplants. KDPI, and not ΒΜΙ, of the deceased donor seems to be a good prognostic factor of renal function at the end of the first year after kidney transplant, whereas high BMI and high KDPI markedly induce DGF.

Outcomes of repeat kidney transplantation following prior graft failure secondary to BK nephropathy: A single-center retrospective study.

BK virus is associated with development of nephropathy (BKVN) that can lead to graft failure after renal transplantation. There are limited data on rates of recurrence and outcomes of repeat renal transplantation after prior graft loss caused by BKVN. After IRB approval, data on all patients who underwent a repeat renal transplantation after prior graft failure as a result of BKVN were identified. Data on management of patients prior to retransplantation, induction and maintenance immunosuppression, and key clinical and virologic outcomes were collected. Descriptive statistics were used for analysis. Thirteen patients were identified over a 13-year period, and follow-up of these patients occurred for a median of 4.7years. Most patients have previous renal transplants removed prior to (7/13, 53.8%) or at the time of retransplantation (3/13, 23.1%). Close virologic monitoring of serum and urine, coupled with early immunosuppression minimization, was associated with few patients developing BK viruria above 1×107 c/mL (4/13, 30.8%), BK viremia above 10,000c/mL (2/13, 15.4%), and biopsy-proven BKVN (1/12, 8.3%); most (8/13, 61.5%) developed BK viruria at any level. Renal function at 1year post-retransplantation was generally excellent and only 1 patient developed graft failure caused by recurrent focal segmental glomerulosclerosis. In our review of the literature, 2 large observational studies of the UNOS database as well as our analysis of case reports showed excellent graft survival and very low rates of recurrent BKVN leading to graft loss. Retransplantation after prior graft failure caused by BKVN generally has low rates of recurrence when coupled with close monitoring and early immunosuppression minimization. Removal of failed renal transplant may allow easier monitoring for recurrence.