Trends in mortality and graft failure for renal transplant patients.
BACKGROUND
Several important advances in general medical management both before and after renal transplantation have occurred over the last 5-15 years, however, few studies have formally examined trends in the outcomes of renal transplantation. We, therefore, aimed to determine the degree to which these advances have resulted in improved outcomes such as survival of patient and graft.


METHODS
We analyzed the rates of death and graft failure among the 11,482 Canadians with end-stage renal disease who received a kidney transplant in 1981-98. Patients were followed from the date of transplantation to the date of graft failure, the date of death or the end of the observation period, namely, Dec. 31, 1998, depending on which was the earliest. Rate ratios for mortality and graft failure--ratios of the rate for each calendar period to the rate for the arbitrarily chosen reference period, 1981-85--were estimated with a piece-wise exponential model that adjusted for age, sex, ethnicity, primary renal diagnosis, follow-up time and donor-organ source.


RESULTS
The rates and adjusted rate ratios for death and graft failure decreased significantly and steadily over time. Relative to 1981-85, the adjusted mortality rate ratios were 0.70 (95% confidence interval [CI] 0.54-0.89), 0.65 (95% CI 0.52-0.82) and 0.53 (95% CI 0.41-0.67) for 1986-89, 1990-94 and 1995-98 respectively, and the adjusted graft failure rate ratios were 0.68 (95% CI 0.60-0.78), 0.62 (95% CI 0.54-0.70) and 0.51 (95% CI 0.44-0.58) respectively. The decrease was mostly among the cadaveric-organ recipients. Calendar period was as important a predictor of outcome as well-known prognostic factors such as age and primary renal diagnosis.


CONCLUSIONS
Decreases in mortality rates are probably related to refinements in patient management. Decreases in graft failure rates are probably the result of a combination of improved immunotherapy and better management of nonimmunologic conditions such as hypertension and hyperlipidemia.
Schaubel
Douglas E
DE
Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, USA.
Jeffery
John R
JR
Mao
Yang
Y
Semenciw
Robert
R
Yeates
Karen
K
Fenton
Stanley S A
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D017211:Treatment Failure