Changes in renal transplantation: comparison between two different series.
BACKGROUND
New immunosuppressives have improved the results of renal transplants. However, the features of donors and recipients have changed, producing an increased age in both cases and more donors dying from strokes. We analyzed the impact of donor and recipient profile on survival of graft in recipients treated with new immunosuppressive agents.


METHODS
Data from 343 patients receiving cadaveric renal transplants functioning for 1 year on February of 1987 and March of 2001 when cyclosporine was incorporated in the immunosuppressive regimen. Two series were distinguished from the point of view of immunosuppression: an historical series and a current series. Graft survival rates were analyzed using the actuarial method. Multivariate analysis was achieved with Cox proportional hazards model.


RESULTS
Actuarial survival at 5 years was lower in the current series, 77%, as opposed to 82% in the historic series. Donor and recipient age, proteinuria, and losses in immediate postoperative period were significantly higher in the current series. However, acute rejection episode dropped from 54% to 21%. Delayed graft function also decreased from 18% to 10% in the current series. When multivariate analysis was performed of grafts functioning at 1 year, the relative risk was 3.12 in the historical series adjusted for other variables.


CONCLUSIONS
The data suggested that new immunosuppressive regimens counteract suboptimal features for donors and recipients.
Marqués
G Gómez
GG
Renal Unit, University Hospital of Son Dureta, Palma de Mallorca, Spain. ggmarques@ono.com
Goenaga
P Errasti
PE
Royo
F J Lavilla
FJ
Fernández
N García
NG
Escolá
J Manrique
JM
Unanua
A Purroy
AP
D000367:Age Factors; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods* / Q000639:trends; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000639:trends*; D015999:Multivariate Analysis; D011507:Proteinuria; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis; D013997:Time Factors