Graft Survival Trends in Kidney Transplants: an Analysis of the UNOS Database.

Goh A.

Clinical Transplants 2009, Chapter 2

Abstract

We have summarized data on 92,636 living donor (LD) and 170,587 deceased donor (DD) kidney transplants reported to the OPTN/UNOS registry from January 1988 to December 2008. The increase in number of kidney transplants performed annually is mainly due to the increase in number of LD. The majority of LD, DD and their respective recipients, come from the 18-50 age group. Sibling donors made up the majority of LD, though there was a greater proportion of donations from unrelated donors than from spouses/partners. Graft survival has been significantly better in the 18-50 age group, compared with younger and older recipients, likely due to their better physical condition and lower number of co-morbidities. Asians appear to have superior graft survival, compared with Whites, Hispanics and Blacks. Part of the reason could be due to a larger proportion of them having an ideal BMI at transplant, as well as a smaller proportion having pre-transplant diabetes mellitus with its associated medical complications, leading to a detrimental effect on graft survival. Furthermore, a greater proportion of Asians had at least a college education compared with recipients of other ethnic groups, suggesting they could have a better understanding of the lifestyle modifications required after kidney transplantation, which would give rise to better compliance and hence better outcomes post-transplant. Delayed graft function (DGF), the absence of urine production in the first 24 hours posttransplant, as well as a lack of decline in serum creatinine by at least 25% in the first week posttransplant were all associated with poor short- and long-term graft survival. An early acute rejection (AR) episode, which could be antedated by any of the above, also leads to poorer short- and long-term outcomes. It is of note that the majority of recipients who underwent re-transplants had a higher PRA compared with first transplants. With their higher immunological risk, it is unsurprising that a significantly higher number had early AR episodes, and hence poorer short- and long-term graft outcomes.