Look-up survival tables for living-donor renal transplants: OPTN/UNOS data 1995-2002.
1. We have provided reference tables of living-donor kidney graft survival rates based on data reported to the OPTN/UNOS Registry between 1995-2002. Graft survival rates from 28,860 living-related (LRD) and 8,444 living-unrelated donor (LUD) kidneys were 6 and 4 percentage points higher, respectively, at one year after-transplantation compared to the rate for deceased donor kidneys (70,801 DD grafts with GS = 89%). Furthermore, living donor recipients enjoyed a 50% increased graft half-life (15 years for LRD and LUD vs. 10 years for DD). Significantly higher short- and long-term functional and patient survival rates were also observed in recipients of living donor kidneys (Fig. 1). 2. The effects of 15 cofactors on graft survival rates were similar across living donor types (Figs. 2-16). Living-donors always exhibited superior rates compared to DD transplants in comparable categories (Table 1). For example, Black recipients of LRD, LUD and DD kidneys demonstrated half lives of 10, 11 and 7 years, respectively, compared to 17, 16 and 11 years in their White counterparts. 3. Among LRD renal transplants, long (20+ year) half-lives were estimated in children (0-10 yrs) and recipients with inherited disease despite the presence of other detrimental factors. When combined with another factor known to promote long-term survival (few HLA mismatches, 0% PRA, no CMV, younger male donor), children's half-lives approached 30+ years. In contradistinction, LRD kidneys grafted into sensitized recipients (regrafted or high PRA) had poor outcomes except when donors were well HLA matched with their recipients. Recipients of older and CMV+ LRD kidneys also exhibited lower graft survival rates. 4. We confirmed the excellent outcomes of LUD renal transplants. Both spouse and other LUD transplants exhibited nearly indistinguishable results. Variations in recipient's pretransplant medical status, donor age and drug regimen tended to influence LUD outcomes more than LRD transplants, whereas HLA mismatches had less impact. This last result is expected since grafts matching a few HLA loci from unrelated individuals will not match (with high probability) remaining MHC loci.
Gjertson
David W
DW
UCLA Immunogenetics Center, Los Angeles, California, USA.
D000206:Actuarial Analysis; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome