title: Progress in renal transplantation. A single center study of 3359 patients over 25 years.
abstract: 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.
authors.affiliation: Department of Surgery, University of Alabama School of Medicine, Birmingham, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Diethelm
authors.forename: M H
authors.initials: MH
authors.lastname: Deierhoi
authors.forename: S L
authors.initials: SL
authors.lastname: Hudson
authors.forename: D A
authors.initials: DA
authors.lastname: Laskow
authors.forename: B A
authors.initials: BA
authors.lastname: Julian
authors.forename: R S
authors.initials: RS
authors.lastname: Gaston
authors.forename: J S
authors.initials: JS
authors.lastname: Bynon
authors.forename: J J
authors.initials: JJ
authors.lastname: Curtis
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents