Improved Long-Term Graft Survival After Deceased Donor Kidney Transplantation in the United States From 1988 to 2007

Introduction: Short-term renal graft survival has been increased dramatically. However, it is still not clear if long-term graft survival improved over time. Methods: We performed a retrospective graft survival analysis of kidney transplant patients registered in the United Network of Organ Sharing (UNOS) registry from 1988 to 2007 with follow-up to 2012. Only primary solitary adult deceased donor kidney transplants were selected. Three eras of transplantation were divided: era1(1988-1994), era2(1995-2001) and era3(2002-2007). Results: There were proportionately more older recipients and donors, African American recipients and donors, and higher recipient body mass index, HLA mismatch and PRA in recent cohorts.Table: No Caption available.The one-year death-censored graft survival increased from 80.1% to 94.4% and five-year survival from 78.0% to 86.4%. Ten-year (1988-2002) survival increased from 55.9% to 65.6%. Compared to era1, the one-year and five-year death-censored graft survival of era3 increased significantly 9% and 7.2% respectively.Figure: No Caption available.It is worth to be noted that the one-year survival improved mainly before 1997-11.1% of total 14.3%. And the five-year and ten-year (1988-2002) survival stayed stable before 1996 and elevated 7.2% and 9.2% respectively after that. This phenomenon was consistent with the evolvement of immunosuppressant. Death with graft function (DWGF) was the most important reason for graft failure that accounted for 42%. Conclusions: The long-term survival of kidney grafts was underestimated for long time. It is a feasible path to improve further long-term outcome by multidisciplinary cooperation to reduce DWGF.