25 Years of Kidney Transplantation--A Period of Change.
At the University of Cologne Hospital, 1062 kidney transplants in adults and 136 pediatric transplants were performed between 1990 and 2014. Immunosuppressive therapy was changed during this time period from a therapy with anti-lymphocyte globulin induction followed by a triple therapy to a period using induction (IL2 receptor antagonists) followed by low dose tacrolimus, mycophenolate mofetil and steroids. Antiviral therapy has been constant during the 25 years, consisting of ganciclovir or valganciclovir. Major change occurred in the age of donors and recipients, with more than a third of both now being older than 65 years. Living donation has increased in number and proportion, at the same time the number of deceased donors rapidly declined. Longer time periods on dialysis resulted not only in an increased risk profile of the recipients, but were also accompanied by a significantly higher number of mismatches for the allocated kidney, since the relative importance of waiting time in the allocation process increased. Multivariate analysis showed that immunological factors such as HLA-match and panel reactive antibody are relevant factors, even in a single center analysis.
Dirk L
DL
Stippel
Tülay
T
Cingöz
Roger
R
Wahbal
Roman-Ulrich
RU
Müller
Ursula
U
Bauerfeind
Georg
G
Dieplinger
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D046148:Donor Selection / Q000639:trends; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006648:Histocompatibility; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D019520:Living Donors / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000639:trends*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
D007166:Immunosuppressive Agents