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Volume 342:605-612 March 2, 2000 Number 9 Next

	Full Text PDF Editorial by Carpenter, C. B. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Parikh, C. PubMed Citation

ABSTRACT

Background The introduction of cyclosporine has resulted in improvement in the short-term outcome of renal transplantation, but its effect on the long-term survival of kidney transplants is not known.

Methods We analyzed the influence of demographic characteristics (age, sex, and race), transplant-related variables (living or cadaveric donor, panel-reactive antibody titer, extent of HLA matching, and cold-ischemia time), and post-transplantation variables (presence or absence of acute rejection, delayed graft function, and therapy with mycophenolate mofetil and tacrolimus) on graft survival for all 93,934 renal transplantations performed in the United States between 1988 and 1996. A regression analysis adjusted for these variables was used to estimate the risk of graft failure within the first year and more than one year after transplantation.

Results From 1988 to 1996, the one-year survival rate for grafts from living donors increased from 88.8 to 93.9 percent, and the rate for cadaveric grafts increased from 75.7 to 87.7 percent. The half-life for grafts from living donors increased steadily from 12.7 to 21.6 years, and that for cadaveric grafts increased from 7.9 to 13.8 years. After censoring of data for patients who died with functioning grafts, the half-life for grafts from living donors increased from 16.9 years to 35.9 years, and that for cadaveric grafts increased from 11.0 years to 19.5 years. The average yearly reduction in the relative hazard of graft failure after one year was 4.2 percent for all recipients (P<0.001), 0.4 percent for those who had acute rejection (P=0.57), and 6.3 percent for those who did not have acute rejection (P<0.001).

Conclusions Since 1988, there has been a substantial increase in short-term and long-term survival of kidney grafts from both living and cadaveric donors.

Source Information

From the Divisions of Nephrology (S.H., B.A.B.) and Transplant Surgery (C.P.J.), Medical College of Wisconsin, Milwaukee; the United Network for Organ Sharing, Richmond, Va. (S.E.T.); and the EMMES Corporation, Potomac, Md. (M.J.M., D.S.). Presented at the 18th Annual Meeting of the American Society of Transplantation, Chicago, May 15–19, 1999.

Address reprint requests to Dr. Hariharan at the Medical College of Wisconsin, Division of Nephrology, 9200 W. Wisconsin Ave., Milwaukee, WI 53226, or at hari{at}mcw.edu.

Full Text of this Article

Related Letters:

Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996
Parikh C., Ellison D. H., Sam R., Leehey D. J., Hariharan S., Stablein D.
Extract | Full Text  
N Engl J Med 2000; 342:1837-1838, Jun 15, 2000. Correspondence

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