Thirty Year Trend in Kidney Transplants: UCLA and UNOS Renal Transplant Registry.
Kaneku HK, Terasaki PI.
Clinical Transplants 2006, Chapter 1
After the analysis of the UNOS Renal Transplant Registry database, with more than 138,000 cases, we showed that: 1. The important improvement seen in the last 20 years is basically only in the short-term graft survivals, with the best advances in the first 6 months after transplant. Unfortunately, the graft loss rate after the first year post-transplant remains the same as observed 10 years ago. The development of new immunosuppression has not been sufficient in avoiding chronic graft rejection. 2. Ten year graft survival has remained essentially the same in the period after 1996 as the reference period of 1987 to 1995. The year at which the transplant had been performed had absolutely no effect in the past 5. As to trends, there was an important shift to older recipients and older donors which has been notable in the 30 years. Living unrelated and spouse donors have increased 10 years on the long-term survival of HLA identical sibling donor, parental and cadaver donor grafts. 3. The factors which had a small effect before, and continued to have a similar small effect were: regrafts, high PRA, and sex of recipient. 4. The factors which had a large effect before and continued to influence long-term survival were: living versus cadaver donor, age of the recipient, age of the donor, original disease of the recipient, race of the recipient, immediate kidney function and delayed graft function. HLA matching had approximately a 15% difference in best and worst mismatches in the earlier and 10% in the later periods. 6. Cold ischemia time has relatively little effect on graft survival or percent of nonfunctional kidneys in all groups.