title: The UNOS Scientific Renal Transplant Registry. United Network for Organ Sharing.
abstract: 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)
authors.forename: J M
authors.initials: JM
authors.lastname: Cecka
authors.forename: P I
authors.initials: PI
authors.lastname: Terasaki
mesh_terms: 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