5,000 kidney transplants--a single-center experience.
Between 6/1963 and 12/1998, 5,069 kidney transplants were done at the University of Minnesota. Of these, about half have been living donor, half cadaver. The majority (83%) have been primary transplants. Recipients were grouped in 6 eras based on changes in our immunosuppressive protocols--6/63-12/67 (n = 98); 1/68-7/79 (n = 1,188); 8/79-6/84 (n = 789); 7/84-9/90 (n = 1,006); 10/90-12/95 (n = 1,050; 1/96-12/98 (n = 718)--and their outcomes were compared. Recent eras contained a higher proportion of recipients aged > 50. Since the inception of the program, there has been a steady improvement in actuarial patient survival, graft survival, and death-censored graft survival. Short-term outcome for primary and retransplant recipients has been similar; however, long-term outcome seems worse for retransplant recipients. Importantly, acute rejection and infectious death have become rare causes of graft loss. Chronic rejection and death with function (most often due to a cardiovascular event) have become the predominant causes of graft loss. Recent changes in immunosuppressive protocols (Era VI) have included more aggressive attempts to maintain CsA levels > 150 ng/ml (by HPLC) in the first 3 months and the substitution of mycophenolate mofetil for azathioprine. As a result, the incidence of acute and chronic rejection has decreased and graft survival has improved.
Moss
A
A
Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Najarian
J S
JS
Sutherland
D E
DE
Payne
W D
WD
Gruessner
R W
RW
Humar
A
A
Kandaswamy
R
R
Gillingham
K J
KJ
Dunn
D L
DL
Matas
A J
AJ
D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006650:Histocompatibility Testing; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012086:Reoperation; D015996:Survival Rate; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D016572:Cyclosporine