Kidney Transplantation: A Review of 45 Years of a Southern Brazilian Hospital.

Kidney transplantation is the best therapeutic option for patients with end-stage kidney disease, providing longer survival and quality of life. This retrospective single-center study analyzed all kidney transplants performed at Hospital São Lucas da PUCRS between 1978 and 2023, categorizing patients into different eras according to the evolution of immunosuppressive protocols. A total of 1,920 transplants were performed, and patient survival at 1, 3, and 5 years was evaluated, which was estimated at 89.6%, 86%, and 82.8%, respectively, for living donors and 85%, 80.3%, and 76.2%, respectively, for deceased donors. The acute rejection rate decreased from 39.2% in the years 1987 to 1997 to 18.8% in the most recent era. The impact of the COVID-19 pandemic was significant, increasing mortality and temporarily reducing the transplant rate. The findings demonstrate improvements in patient and graft survival over the years, in line with advances in surgical and immunosuppressive techniques. However, challenges such as infections and chronic complications remain relevant. Future studies should focus on optimizing clinical management and mitigating the impacts of health crises on the transplant population.