Long-term improvement of deceased donor renal allograft survival since 1996: a single transplant center study.
BACKGROUND
The rate of acute rejection (AR) has decreased significantly, but whether this is associated with improvement in long-term graft survival is controversial.


METHODS
We analyzed 1445 consecutive adult deceased donor kidney transplant recipients from 1985 to 2005, over two periods (1985-1995 vs. 1996-2005) to compare long-term graft survival.


RESULTS
The second period was associated with older donors and recipients and a reduction in AR. A significant increase of 10.1 months at 11 years was seen in death-censored graft survival in 1996 to 2005. For this posttransplant time, graft half-life was 10.8 years in 1985 to 1995, while at this point in the second period 62% of recipients had a functioning graft. The yearly increase in serum creatinine was less pronounced in the latter period (0.05 mg/dL vs. 0.02 mg/dL, P<0.01). No difference was found in patient survival. Cox analysis showed that donor age (HR 1.02, P<0.001), AR (HR 1.72, P<0.001), panel-reactive antibody at transplantation (HR 1.01, P<0.001), and serum creatinine at 1 year (HR 2.01, P<0.001) had a negative impact on graft outcome. By contrast, the use of mycophenolate mofetil was associated with a 24% reduction in graft loss rate (HR 0.76, P<0.05).


CONCLUSIONS
Long-term graft survival and renal function have improved in renal transplant recipients since 1996.
Sola
Eugenia
E
Division of Nephrology, Carlos Haya University Hospital, Malaga, Spain.
Gonzalez-Molina
Miguel
M
Cabello
Mercedes
M
Burgos
Dolores
D
Ramos
Jose
J
Gutierrez
Cristina
C
Lopez
Veronica
V
Soler
Jorge
J
de la Vega
Encarnacion
E
Hernandez
Domingo
D
D000208:Acute Disease; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents