Kidney graft survival in Europe and the United States: strikingly different long-term outcomes.
BACKGROUND
Kidney graft survival has never been systematically compared between Europe and the United States.


METHODS
Applying period analysis to first deceased-donor (DD) and living-donor kidney grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year graft survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics.


RESULTS
For the 2005 to 2008 period, 1-year survival for DD grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year graft survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor grafts were similar as those seen for DD grafts. Adjusted hazard ratios for graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower graft survival is not explained by differences in baseline patient characteristics.


CONCLUSIONS
Long-term kidney graft survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term graft survival differences between Europe and the United States is a high priority for improving long-term graft survival.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. a.gondos@dkfz.de
Adam
A
Gondos
Bernd
B
Döhler
Hermann
H
Brenner
Gerhard
G
Opelz
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005060:Europe; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000009:adverse effects / Q000208:ethnology / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D019520:Living Donors; D008875:Middle Aged; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
D007166:Immunosuppressive Agents