Patterns of graft and patient survival following renal transplantation and evaluation of serum creatinine as a predictor of survival: a review of data collected from one clinical centre over 34 years.
BACKGROUND
The pattern of renal transplantation has never been described since the introduction of the technique. The purpose of this study was therefore to characterise the pattern of renal transplantation from 1967 to 2000, focusing on renal graft function as a predictor of survival.


METHODS
This study was a retrospective analysis of an electronic database. The setting was a single renal transplant centre in the United Kingdom covering a population of 2.2 million and included patients who received at least one renal transplant over the study period (n = 1516). The main outcome measures were patient and graft survival, acute rejection episodes and patterns of graft function, as measure by creatinine levels.


RESULTS
There were 559 (36.8%) female patients; 109 (7.2%) patients had pre-existing diabetes. Patient survival was adversely affected by increased age at transplant (p < 0.001): 5-year patient survival from first transplant was 82% for patients aged 0 to 17 years, 80% for 18 to 49 years and 61% for > 49 years. Pre-existing diabetes also adversely affected survival (p < 0.01): 5-year graft survival was 63% for patients with diabetes versus 74% for those without. Graft survival was significantly associated with serum creatinine levels recorded 1 year post-primary transplant (p < 0.001) and with three or more acute rejection episodes (p < 0.05). Neither gender nor diabetes status were statistically significant in predicting graft survival. The number of acute rejection episodes was significantly greater in patients with pre-existing diabetes than those without (61% versus 42%, respectively; p < 0.001). There were no differences in the number of acute rejection episodes occurring across age groups.


CONCLUSIONS
Patient and graft survival improved markedly over the 34-year study period, although patient survival has changed little since 1990. Serum creatinine levels are a reliable predictor of graft survival.
McEwan
Phil
P
School of Mathematics, Cardiff University, Cardiff, UK.
Baboolal
Keshwar
K
Dixon
Simon
S
Conway
Pete
P
Currie
Craig J
CJ
D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013534:Survival
D003404:Creatinine