title: Twenty-year survivors of kidney transplantation.
abstract: There have been few studies of patients with renal allografts functioning for more than 20 years. We sought to identify clinical factors associated with ultra long-term (>20 year) renal allograft survival and to describe the clinical features of these patients. We performed a retrospective analysis of the Irish Renal Transplant Database and included 1174 transplants in 1002 patients. There were 255 (21.74%) patients with graft function for 20 years or more. Multivariate analysis identified recipient age (HR 1.01, CI 1.01-1.02), gender (male HR 1.25, CI 1.08-1.45), acute rejection (HR 1.26, CI 1.09-1.45) and transplant type (living related donor vs. deceased donor) (HR 0.52, CI 0.40-0.66) as significantly associated with long-term graft loss. Median serum creatinine was 115 μmol/L. The 5-year graft survival in 20-year survivors was 74.7%. The mean age at death was 62.7 years (±10.6). The most common causes of death were cardiovascular disease and malignancy. The two major causes of graft loss were death (with function) and interstitial fibrosis/tubular atrophy. Comorbidities included skin cancer (36.1%), coronary heart disease (17.3%) and other malignancies (14.5%). This study identifies factors associated with long-term allograft survival and a high rate of morbidity and early mortality in long-term transplant recipients.
authors.affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland. caroltraynor@physicians.ie
authors.forename: C
authors.initials: C
authors.lastname: Traynor
authors.forename: A
authors.initials: A
authors.lastname: Jenkinson
authors.forename: Y
authors.initials: Y
authors.lastname: Williams
authors.forename: P
authors.initials: P
authors.lastname: O'Kelly
authors.forename: D
authors.initials: D
authors.lastname: Hickey
authors.forename: M
authors.initials: M
authors.lastname: Denton
authors.forename: C
authors.initials: C
authors.lastname: Magee
authors.forename: P J
authors.initials: PJ
authors.lastname: Conlon
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors