Patient survival after renal transplantation; more than 25 years follow-up

Background: The determinators of patient survivalafter renal transplantation are incompletely known, and conflicting resultshae been reported. This may have been influenced by time-related changes inpatients selection, post-transplantation management and immunosuppressiveregimens. This study was performed to evaluate in recipients of a firstrenal transplant the effect of patient characteristics, transplantationera, and the immunosuppressive regimen on patient survival.Method: We studied data from the Leiden RenalTransplant Database of all first renal transplantations performed between1966 and 1994 in Leiden, the Netherlands. The effect of the followingparameters on mortality was investigated: era of transplantation, sex, ageat transplantation, cause of renal failure, immunosuppressive regimen, typeand duration of pretransplantation dialysis, hypertension, diabetesmellitus, and smoking. In addition we analysed the causes of death. Resultswere expressed as crude mortality rates, relative risks of mortality, andstandardized mortality ratios as compared with death rates in the Dutchpopulation. Results: The analysis comprised 86 livingdonor transplant recipients and 916 cadaver transplant recipients. Afteradjustment for age and sex, the relative risk of morality for living donortransplant recipients compared with cadaver transplant recipients was 0.5(95% CI 0.2 to 10.3, P=0.06). In the first cadaver kidney transplantrecipients the risk of first-year mortality improved significantly withtime, which coincided with the introduction of cyclosporin. The risk ofmortality after the first year was higher in patients aged over 40 years attransplantation, men, smokers, and in the presence of hypertension ordiabetes, but the effect of individual factors on mortality was small. Wefound no effect of the type of pretransplantation dialysis or the durationof pretransplantation haemodialysis on post-transplantation mortality. Thestandardized mortality ratio for recipients of first renal transplants was14 times the population average in the first year after transplantation andwas still four times in the remaining years.Conclusion: In the present study, time-related changesin patient management were responsible for improved patient survival in thefirst year after transplantation during the study period. Many individualfactors contributed moderately to the risk of mortality after the firstyear. Compared to the general population the mortality rate of renaltransplant recipients was significantly higher during the whole follow-upperiod.