The UNOS Scientific Renal Transplant Registry. United Network for Organ Sharing.
1. The number of cadaveric transplants performed each year at United States transplant centers has increased very little, from 7,200 in 1988 to 8,100 in 1993. Living-donor transplants increased during the same period from 1,656 to 2,562. 2. The recipient and donor populations have aged since UNOS began collecting data. In 1988, 39% of first-cadaver transplant recipients were over age 45 compared with 45% in 1993. During the same period, the percentage of cadaver kidneys from donors over age 45 increased from 16% to 26%. 3. Recipients over age 60 or under age 19 had 65% 3-year graft survival rates compared with 70% for those in the intervening age groups (p < 0.001). As many as 60% of graft failures after the first year were accounted for by deaths with a functioning graft when the recipient was over 60 compared with less than 15% when the patient was under age 30 (p < 0.01). Rejection caused 45% of graft failures after the first year for recipients under age 45 but only 17% in those over 60 (p < 0.01). When deaths were censored in the graft survival calculation, recipients over age 45 had the highest 3-year survival rate of 79% compared with 72% for those aged 6-18 (p < 0.001). 4. The 3-year graft survival rate for kidneys from donors over age 60 was 55% and from donors aged 46-60 or under 5, it was 58%. Both results were significantly poorer than the 75% survival rate achieved using kidneys from 19 to 30 year-olds. 5. The racial distribution among first-cadaver kidney transplants has been relatively stable between 1988 and 1993, with 60% Whites, 23% Blacks, 8% Hispanics, 3% Asians, and the remainder, other groups. One-year graft survival rates were consistently 3-5% lower for Blacks than for other races (p < 0.001), and the difference increased to 12% by 3 years. The poorer survival rates for Blacks were unaffected by the donor's race. Blacks had the highest patient survival rates. More than 38% of first year failures and 47% of later failures in Blacks were due to rejection, compared with 31% for Whites in both periods (p < 0.01). When deaths were censored from the survival calculation, the graft half-life increased from 11 to 15 years for Whites but only from 5 to 6 years for Blacks. 6. Diabetes became the most prevalent disease among first-cadaver transplant recipients, accounting for 28% of the 1993 activity.(ABSTRACT TRUNCATED AT 400 WORDS)
Cecka
J M
JM
Terasaki
P I
PI
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000706:statistics & numerical data; D007223:Infant; D007674:Kidney Diseases / Q000453:epidemiology / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology