Progress in renal transplantation. A single center study of 3359 patients over 25 years.
OBJECTIVE
The study analyzed 3359 consecutive renal transplant operations for patient and graft survival, including living related, cadaveric, and living unrelated patients. The analysis was separated into three groups according to immunosuppression and date of transplant.


BACKGROUND
Improvements in renal transplantation in the past 25 years have been the result of better immunosuppression, organ preservation, and patient selection.


METHODS
A single transplant center's experience over a 25-year period was analyzed regarding patient and graft survival. Potential risk factors included patient demographics, tissue typing, donor characteristics, number of transplants, acute and chronic rejection, acute tubular necrosis, primary disease, and malignancy.


RESULTS
The primary cause of graft loss was rejection. Improvement in cadaveric graft survival since 1987 with quadruple therapy was not apparent in living donor patients. Race continued to be a negative factor in graft survival. Avoiding previous mismatched antigens and the use of flow cytometry improved allograft survival. The leading cause of death in the past 7 years in cadaveric recipients was cardiac (52%).


CONCLUSIONS
Improved graft survival in the past 25 years was related to 1) advances in immunosuppression, 2) better methods of cytotoxic antibody detection, and 3) human lymphocyte antigen match.
Diethelm
A G
AG
Department of Surgery, University of Alabama School of Medicine, Birmingham, USA.
Deierhoi
M H
MH
Hudson
S L
SL
Laskow
D A
DA
Julian
B A
BA
Gaston
R S
RS
Bynon
J S
JS
Curtis
J J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014181:Transplantation Immunology
D007166:Immunosuppressive Agents