title: Comparison of the long-term outcomes of kidney transplantation: USA versus Spain.
abstract: BACKGROUND
  The long-term outcomes of kidney transplantation are suboptimal because many patients lose their allografts or experience premature death. Cross-country comparisons of long-term outcomes of kidney transplantation may provide insight into factors contributing to premature graft failure and death. We evaluated the rates of late graft failure and death among US and Spanish kidney recipients.
  
  
  METHODS
  This is a cohort study of US (n = 9609) and Spanish (n = 3808) patients who received a deceased donor kidney transplant in 1990, 1994, 1998 or 2002 and had a functioning allograft 1 year after transplantation with follow-up through September 2006. Ten-year overall and death-censored graft survival and 10-year overall recipient survival and death with graft function (DWGF) were estimated with multivariate Cox models.
  
  
  RESULTS
  Among recipients alive with graft function 1 year after transplant, the 10-year graft survival was 71.3% for Spanish and 53.4% for US recipients (P < 0.001). The 10-year, death-censored graft survival was 75.6 and 76.0% for Spanish and US recipients, respectively (P = 0.73). The 10-year recipient survival was 86.2% for Spanish and 67.4% for US recipients (P < 0.001). In recipients with diabetes as the cause of ESRD, the adjusted DWGF rates at 10 years were 23.9 and 53.8 per 1000 person-years for Spanish and US recipients, respectively (P < 0.001). Among recipients whose cause of ESRD was not diabetes mellitus, the adjusted 10-year DWGF rates were 11.0 and 25.4 per 1000 person-years for Spanish and US recipients, respectively.
  
  
  CONCLUSIONS
  US kidney transplant recipients had more than twice the long-term hazard of DWGF compared with Spanish kidney transplant recipients and similar levels of death-censored graft function. Pre-transplant medical care, comorbidities, such as cardiovascular disease, and their management in each country's health system are possible explanations for the differences between the two countries.
authors: Department of Medicine, University of Michigan, Ann Arbor, MI, USA. aojo@umich.edu
authors: Akinlolu O
authors: AO
authors: Ojo
authors: José María
authors: JM
authors: Morales
authors: Miguel
authors: M
authors: González-Molina
authors: Diane E
authors: DE
authors: Steffick
authors: Fu L
authors: FL
authors: Luan
authors: Robert M
authors: RM
authors: Merion
authors: Tammy
authors: T
authors: Ojo
authors: Francesc
authors: F
authors: Moreso
authors: Manuel
authors: M
authors: Arias
authors: Josep María
authors: JM
authors: Campistol
authors: Domingo
authors: D
authors: Hernandez
authors: Daniel
authors: D
authors: Serón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013030:Spain; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult