Long-term improvement of deceased donor renal allograft survival since 1996: a single transplant center study.

ABSTRACT

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). CONCLUSION: Long-term graft survival and renal function have improved in renal transplant recipients since 1996.