Ultra-long survivors of kidney transplantation: forty years and more of graft function.

BACKGROUND

It has been over 60 years since the first kidney transplant in Ireland was carried out in 1964. We examined the Irish cohort of individuals with allografts functioning for more than 40 years. We sought to describe the features of these patients and identify clinical factors associated with ultra-long-term allograft survival.

METHODS

This retrospective analysis of the Irish National Kidney Transplant Registry included kidney transplants performed in Ireland between January 1st, 1970, and March 31st, 1983. Follow-up analysis was until March 31st, 2023.

RESULTS

There were 428 transplants in 394 patients. Longitudinal data were available for 390 (98.9%) patients. Thirty-three (33/428, 7.7%) kidney transplant grafts survived for 40 years or more, with 25 grafts functioning at date of analysis. Multivariable analysis identified transplant type-living donor versus deceased donor (odds ratio [OR] 3.51, confidence interval [CI] 1.17-11.1, P = .027) as significantly associated with long-term graft survival. The median serum creatinine of patients with surviving transplants was 107 µmol/L (range 66-322 µmol/L). Non-melanoma skin cancer was common, affecting 22/33 (67%) patients.

CONCLUSIONS

For ultra-long survivors, graft function is excellent if patients are maintained on low-level immunosuppression. Living donor transplantation, but not donor or recipient age or sex, was associated with improved graft survival.