Outcome statistics of renal transplants with an emphasis on long-term survival.

Remarkable increases in cadaveric renal transplant survival rates have been seen following improvements in areas such as immunosuppression, organ preservation, HLA typing and cross-matching, and blood transfusion protocols. However, while these improvements have influenced survival in the early post-transplant period up to 6 months, the cumulative rate of graft loss beyond the 1st year has remained constant at about 9% a year over the past 25 years. Several factors that affect long-term survival have been identified through univariate and multivariate analyses. Chief among these is the detrimental effect of HLA-A and HLA-B antigen mismatching. Also important are the recipient's race, sex, and age, and presence of diabetes, as well as the donor's age, sex, and cause of death, and long cold ischemia times. Likewise, post-transplant events, including delayed graft function, early rejection episodes, and discharge serum creatinine levels strongly affect long-term graft survival. Chronic rejection should also be recognized as a major contributor to the long-term failure rate, but there is currently no reliable way to identify or classify it in the UNOS Scientific Renal Transplant Registry database. Characteristics that define chronic rejection must be identified to allow transplant centers to accurately report its incidence and to enable investigators to analyze and monitor its impact on transplant outcome.