Patient survival after renal transplantation
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Kidney transplantation is the treatment of choice for selected patients with end-stage renal disease (ESRD) . A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis [2-4]. Survival rates posttransplantation are similar for both hemodialysis and peritoneal dialysis patients .
The following discussion will review the data relating to patient survival in patients undergoing renal transplantation. The determinants of short-term and long-term graft survival are discussed separately. (See "Risk factors for graft failure in kidney transplantation".)
Graft and patient survival after kidney transplantation have improved over the past decade. Death-censored graft survival has increased steadily over the past decade in both adults and pediatric recipients . Data provided by the Scientific Registry of Transplant Recipients (SRTR) demonstrate a 10-year overall graft survival for both living and deceased donors of approximately 55 to 60 percent compared with 35 to 40 percent from a decade prior. Death-censored graft survival in particular has improved, while death with a functioning graft has increased over the decade, mitigating improvements in overall graft survival. This is likely a reflection of better immunosuppression in the former and an older patient population with greater comorbidities in the latter.
The long-term advantages of living-donor versus deceased-donor kidney transplant are best appreciated in those with long expected longevity and fewer comorbidities, such as the pediatric population.
Among adults, both early graft loss within 90 days from transplant and estimated glomerular filtration rate (GFR) at one year following transplant improved over the last decade. A retrospective study comparing transplant outcomes (from all donor types; n = 202 expanded criteria, 642 standard criteria, and 673 living-donor transplants) to outcomes of 173 patients in an intensive home hemodialysis program (16 hours per week) in Canada demonstrated the advantage of transplantation, with a reduction in risk of mortality and treatment failure (defined as either permanent switch to alternative dialysis modality or graft loss) of over 50 percent among those transplanted, despite a higher rate of hospitalizations in the transplant cohort within the first three months .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ESTIMATED POSTTRANSPLANT SURVIVAL
- FACTORS ASSOCIATED WITH PATIENT SURVIVAL
- Allograft source
- Patient and deceased-donor age
- Comorbid conditions
- - Cardiovascular disease
- - Diabetes mellitus
- Overall immunosuppression
- Allograft function
- CAUSES OF DEATH
- SURVIVAL COMPARED WITH DIALYSIS
- Reasons for improved survival
- INFORMATION FOR PATIENTS