Late renal allograft failure between 1990 and 1998 in Spain: a changing scenario.
BACKGROUND
Our aim was to study time-dependent modifications in the characteristics of renal transplants in Spain during the 1990s and risk factors associated with death-censored graft failure after the first year.


METHODS
A total of 3,365 adult patients who underwent transplantation in 1990, 1994, and 1998 with a functioning graft after the first year were included.


RESULTS
Ten-year patient and graft survival rates were 82% and 70%. Major modifications between 1990 and 1998 were increases in donor age (32 +/- 15 to 43 +/- 18 years, P<0.0001) and number of HLA mismatches (2.8 +/- 1.2 to 3.2 +/- 1.2, P<0.0001). Acute rejection decreased from 39% to 25% (P<0.0001), and the prevalence recipients with hepatitis C virus decreased from 29% to 10% (P<0.0001). The use of lipid-lowering agents during the first year increased from 6% to 41% (P<0.0001). Projected renal allograft half-life estimate was 15.4 (range, 14.1-16.8) years in 1990 and 17.7 (range, 14.0-21.4) in 1998 (P=0.007). Independent variables associated with graft survival were as follows: recipient age, last panel-reactive antibodies, acute rejection, hepatitis C virus antibodies in the recipient, triglycerides, serum creatinine and proteinuria at 3 months, and the increase of serum creatinine and proteinuria between the 3rd and 12th month. The use of statins during the first year was associated with a decreased risk for graft loss.


CONCLUSIONS
Despite worsening of surrogate parameters of renal quality and poorer HLA matching, graft survival improved during the 1990s in Spain.
Serón
Daniel
D
Nephrology Department, Hospital Universitario de Bellvitge, Barcelona, Spain. 17664dsm@comb.es
Arias
Manuel
M
Campistol
Josep Maria
JM
Morales
José Maria
JM
D000328:Adult; D002648:Child; D003710:Demography; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure
D007166:Immunosuppressive Agents