The Barnes-Jewish Hospital/Washington University Renal Transplant Program: comparison of two eras 1991-1994 and 1995-2000.
The first cadaveric transplant at Barnes-Jewish Hospital/Washington University was performed in 1963, the first living related transplant in 1965, and the first living unrelated transplant in 1983. Changes in the renal transplant program initiated in 1993 and 1994 resulted in many improvements over the past decade. Our comparison of 2 modern eras of transplant, 1991-1994 and 1995-2000, showed the following: 1. No significant differences in patient and donor characteristics. 2. Trends toward greater use of living donors (p = 0.07), older cadaveric donors (p = 0.084) and particularly cadaveric donors > 55 years of age (p = 0.09). 3. Decreasing mean CIT: 19.2 hours vs. 14.2 hours (p < 0.001). 4. Decreasing use of donors with CIT > 24 hours: 22% to 3%, (p < 0.001). 5. Decreased rate of DGF: 13% vs. 8% (p = 0.044). 6. Decreased rate of symptomatic CMV: 35% vs. 14% (p < 0.001). 7. Decreased rate of PTLD: 3.5% vs. 0.5% (p = 0.004). 8. Decreased one-year rate of acute rejection: 41% vs. 15% (p < 0.001). 9. Current one-year rate of acute rejection < 8%. 10. Decreased length of initial hospital stay: 12.7 days to 8.0 days (p < 0.001). 11. Decreased length of hospital in the first year after transplant: 10.6 days vs. 6.4 days (p < 0.001). 12. There were no improvements in patient and graft survival at one and 3 years. a. one-year patient survival rates: 95% vs. 96%. b. 3-year patient survival rates: 90% vs. 90%. c. one-year death-censored graft survival rates: 91% vs. 94%. d. 3-year death-censored graft survival rates: 87% vs. 88%.
Brennan
D C
DC
Renal Transplant Program, Barnes-Jewish Hospital, St Louis, Missouri, USA.
Schnitzler
M A
MA
Ceriotti
C
C
Miller
B W
BW
Wang
C
C
Hardinger
K
K
Shenoy
S
S
Jendrisak
M
M
Phelan
D
D
Mohanakumar
T
T
Lowell
J A
JA
D000046:Academic Medical Centers; D000375:Aging / Q000502:physiology; D002102:Cadaver; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D014850:Waiting Lists
D006680:HLA Antigens