Journal Article•
The UNOS Scientific Renal Transplant Registry.
TL;DR: Based upon data reported to the UNOS Scientific Renal Transplant Registry regarding transplants performed between 1994-1998, the one- and 3-year graft survival rates for 16,288 recipients of living donor kidneys were 93% and 86%, respectively, with a half-life of 17 years.
Abstract: Based upon data reported to the UNOS Scientific Renal Transplant Registry regarding transplants performed between 1994-1998, the one- and 3-year graft survival rates for 16,288 recipients of living donor kidneys were 93% and 86%, respectively, with a half-life of 17 years Among those were 2,129 transplants from HLA-identical siblings with one- and 3-year graft survival rates of 96% and 93% and a 39-year half-life, 3,140 sibling donor grafts matched for one HLA haplotype with 94% and 87% one- and 3-year survival rates and a 16-year half-life and 2,071 transplants from living unrelated donors with 92% and 86% one- and 3-year graft survival rates and a 17-year half-life The overall results of 35,289 cadaver donor kidney transplants were 87% and 76% graft survival at one- and 3-years with a 10-year half-life There was a 13% difference in 3-year graft survival rates when recipients of kidneys from donors over or under age 55 were considered separately and the half-life was 11 years for younger donors and 6 years when the donor was older (p < 0001) A total of 4,688 (14%) of cadaver kidney recipients received an HLA-matched transplant Their graft survival rates were 89% and 83% at one and 3 years and their graft half-life was 16 years compared with 86% and 76% one- and 3-year graft survival and a 10-year half-life for recipients of HLA-mismatched kidneys (p < 0001) The recipient's age affected both graft survival and the cause of graft loss Recipients aged 19-45 had a 78% 3-year graft survival rate compared with 72% for recipients over age 60 or under 18 (p < 0001) However, 65% of graft losses after the first year among older recipients were due to death with a functioning graft compared with 18% among 19-45-year olds Acute rejections accounted for 16% of graft failures after the first year when the recipient was aged 6-18 Immune failures decreased with increasing recipient age The recipient's race also influenced graft survival rates Asian recipients of cadaver kidneys had the highest graft survival rates of 91% and 85% at one and 3 years with a half-life of 18 years The result for Whites and Blacks were significantly lower (87-86% at one year and 78% and 70% at 3 years, respectively; p < 0001) The graft half-life was 12 years for Whites and 7 years for Blacks DGF and acute rejection episodes during the early posttransplant period reduced 3-year survival of cadaveric transplants by 20% and reduced graft half-lives by 2 years (rejections) or 4 years (DGF) When rejections occurred in recipients with DGF, 3-year graft survival was 64% Induction therapy with anti-T-cell reagents did not affect graft survival rates among patients with DGF, but reduced the incidence of early rejections from 27-14% Rejections that occurred within the first 6 months had a more pronounced effect on subsequent graft half-lives (116 years without and 76 years with; p < 001) and increased the proportion of kidneys that failed because of chronic rejection from 31-43% between 1-3 years More than 50% of diabetics received a simultaneous pancreas kidney transplant during this period and the graft and patient survival rates were significantly higher for recipients of the SPK transplants When deaths with a functioning graft were censored, however, the graft failure rates were not significantly different The major causes of death among cadaver kidney transplant recipients were cardiovascular (26%) and infections (24%) during the first posttransplant year Between 1-3 years, the percentage of deaths due to infection fell to 15% and malignancies accounted for 13% of patient deaths
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TL;DR: Spouses are an important source of living-donors kidney grafts because, despite poor HLA matching, the graft-survival rate is similar to that of parental-donor kidneys.
Abstract: Background In the United States, increasing numbers of persons are donating kidneys to their spouses. Despite greater histoincompatibility, the survival rates of these kidneys are higher than those of cadaveric kidneys. We examined the factors influencing the high survival rates of spousal-donor kidneys. Methods Kidney-transplant data from the United Network for Organ Sharing Renal Transplant Registry were used to calculate graft-survival rates with Kaplan–Meier analysis. Results The three-year survival rates were 85 percent for kidneys from 368 spouses, 81 percent for kidneys from 129 living unrelated donors who were not married to the recipients, 82 percent for kidneys from 3368 parents, and 70 percent for 43,341 cadaveric kidneys. The three-year survival rate for wife-to-husband grafts was 87 percent, which was the same as for husband-to-wife grafts if the wife had never been pregnant. If the wife had previously been pregnant, the three-year graft-survival rate was 76 percent (P = 0.40). The three-year...
1,180 citations
TL;DR: Use of sirolimus reduced occurrence and severity of biopsy-confirmed acute rejection episodes with no increase in complications and further studies are needed to establish the optimum doses for the combined regimen.
905 citations
TL;DR: End-stage renal disease time is arguably the strongest independent modifiable risk factor for renal transplant outcomes and a cadaveric renal transplant recipient with an ESRD time less than 6 months has the equivalent graft survival of living donor transplant recipients who wait on dialysis for more than 2 years.
Abstract: Background. Waiting time on dialysis has been shown to be associated with worse outcomes after living and cadaveric transplantation. To validate and quantify end-stage renal disease (ESRD) time as an independent risk factor for kidney transplantation, we compared the outcome of paired donor kidneys, destined to patients who had ESRD more than 2 years compared to patients who had ESRD less than 6 months. Methods. We analyzed data available from the U.S. Renal Data System database between 1988 and 1998 by Kaplan-Meier estimates and Cox proportional hazards models to quantify the effect of ESRD time on paired cadaveric kidneys and on all cadaveric kidneys compared to living-donated kidneys. Results. Five- and 10-year unadjusted graft survival rates were significantly worse in paired kidney recipients who had undergone more than 24 months of dialysis (58% and 29%, respectively) compared to paired kidney recipients who had undergone less than 6 months of dialysis (78% and 63%, respectively; P<0.001 each). Ten-year overall adjusted graft survival for cadaveric transplants was 69% for preemptive transplants versus 39% for transplants after 24 months on dialysis. For living transplants, 10-year overall adjusted graft survival was 75% for preemptive transplants versus 49% for transplants after 24 month on dialysis. Conclusions. ESRD time is arguably the strongest independent modifiable risk factor for renal transplant outcomes. Part of the advantage of living-donor versus cadaveric-donor transplantation may be explained by waiting time. This effect is dominant enough that a cadaveric renal transplant recipient with an ESRD time less than 6 months has the equivalent graft survival of living donor transplant recipients who wait on dialysis for more than 2 years.
720 citations
TL;DR: Recent improvements in graft half-life are related to conservation of renal function within the first year post-transplantation, and one-year creatinine and Delta Creatinine values predict long-term renal graft survival.
683 citations
Cites background or methods from "The UNOS Scientific Renal Transplan..."
...Among these include: recipient age, sex, race); transplant variables (cadaver versus living donor, race, presence of diabetes, delayed graft function (DGF), cold ischemia time, HLA mismatching, delayed graft function and transplant year), and post-transplant variables (immuno- HLA mismatching, and acute rejection episodes [2–4]....
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...long-term graft survival [3, 4, 10]....
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...In previous studies, discharge creatinine was identified The current shortage of organs for transplantation underscores the importance of optimizing long-term graft as a strong predictor of transplant survival [4]....
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...82 mg/dL in 1998 (P creatinine values [4–8]....
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...Graft half-life was used to measure longgraft survival [4–8]....
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TL;DR: Measurement of mRNA encoding cytotoxic proteins in urinary cells offers a noninvasive means of diagnosing acute rejection of renal allografts and identified those in whom acute rejection developed.
Abstract: Background Acute rejection is a serious and frequent complication of renal transplantation, and its diagnosis is contingent on the invasive procedure of allograft biopsy. A noninvasive diagnostic test for rejection could improve the outcome of transplantation. Methods We obtained 24 urine specimens from 22 renal-allograft recipients with a biopsy-confirmed episode of acute rejection and 127 samples from 63 recipients without evidence of acute rejection. RNA was isolated from the urinary cells. Messenger RNA (mRNA) encoding the cytotoxic proteins perforin and granzyme B and a constitutively expressed cyclophilin B gene were measured with the use of a competitive, quantitative polymerase-chain-reaction assay, and the level of expression was correlated with allograft status. Results The log-transformed mean (±SE) levels of perforin mRNA and granzyme B mRNA, which encode cytotoxic proteins, but not the levels of constitutively expressed cyclophilin B mRNA, were higher in the urinary cells from the 22 patients...
589 citations