Twenty-five years of renal transplantation from a single center: a risk factor analysis for short- and long-term outcomes.
Between 1966 and 1991 a total of 1000 renal transplants were performed in Erlangen-Nuremberg. Patients were operated upon in Erlangen and transferred immediately 25 km to Nuremberg for their postoperative and immunosuppressive care. Despite these considerable logistical obstacles, the 10-year graft survival rate in 785 consecutive transplants performed between 1980 and 1990 was 44%, while patient survival was 84%. Mismatch at the HLA-DR locus, preformed antibodies, multiple transplants, and kidneys from donors aged 10 years or younger or over 60 years were risk factors for decreased graft survival. An immunosuppressive regimen of cyclosporine and methylprednisolone resulted in better graft survival than did azathioprine and methylprednisolone, or reduced-dose cyclosporine, azathioprine, and methylprednisolone. The cyclosporine and methylprednisolone regimen had a better patient survival than azathioprine and methylprednisolone. A hazard analysis demonstrated a particular risk of late rejection between the 70th and 90th months, after transplantation. Our data indicate that favorable transplant results can be obtained despite major logistical disadvantages. Very close cooperation between referring centers, transplant surgeons, and nephrologists is indispensable for success.
Neumayer
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HH
Medizinishe Klinik mit Schwerpunkt Nephrology, Charité Campus Mitte, Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany. hans-h.neumayer@charite.de
Luft
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FC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D005858:Germany; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents