Current challenges in renal transplantation from deceased donors.
The results of 3,165 kidney transplants from deceased donors during the 3 time periods, 1986-92 (n=882), 1993-99 (n=1,107) and 2000-06 (n=1,176) were analysed and following conclusions could be made: 1. One-year patient survival improved from 93.2% to 98.1%, one-year graft survival improved from 86.1% to 95.1% and one-year death censored graft survival improved from 90.4% to 96.6%. Patient death due to cardiovascular disease decreased significantly. Despite that, patient death with a functioning graft became the main cause of graft loss after the first posttransplant year in our most recent cohort. The estimated graft half-life has improved from 9.3 to 20.4 years. 2. The rejection incidence decreased from 28.1% to 14.1%. 3. The mean donor age increased from 35.5 to 47.8 years. The proportion of donors fulfilling the UNOS criteria for extended criteria donors increased from 2.9% to 26.3%. The long-term effects of donor factors on these transplants need to be critically evaluated. 4. A good HLA match remains a sound basis for kidney allocation. Provisions should be made for highly immunized patients and those with unusually long waiting times.
Salmela
Kaija
K
Division of Transplantation, 4th Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Kyllönen
Lauri
L
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002102:Cadaver; D005387:Finland / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data