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Related Experiment Videos

5,000 kidney transplants--a single-center experience.

A Moss1, J S Najarian, D E Sutherland

  • 1Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

Clinical Transplants
|August 22, 2001
PubMed
Summary

Kidney transplant outcomes have steadily improved since 1963, with newer immunosuppressive protocols reducing rejection. Chronic rejection and cardiovascular events now cause most graft loss, not acute rejection or infections.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Medical History

Background:

  • The University of Minnesota performed 5,069 kidney transplants between June 1963 and December 1998.
  • Transplants included both living donor and cadaveric donors, with 83% being primary transplants.

Purpose of the Study:

  • To compare kidney transplant outcomes across six distinct eras defined by changes in immunosuppressive protocols.
  • To analyze trends in patient survival, graft survival, and causes of graft loss over a 35-year period.

Main Methods:

  • Recipients were grouped into six eras based on immunosuppressive protocol changes.
  • Outcomes including actuarial patient survival, graft survival, and death-censored graft survival were compared across eras.
  • Causes of graft loss were analyzed, distinguishing between acute rejection, chronic rejection, infectious death, and death with function.

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Main Results:

  • Actuarial patient and graft survival rates showed steady improvement throughout the study period.
  • Acute rejection and infectious deaths became rare causes of graft loss.
  • Chronic rejection and death with function, primarily cardiovascular events, emerged as the leading causes of graft loss.
  • Recent protocols (Era VI) involving aggressive Cyclosporine (CsA) maintenance and mycophenolate mofetil use decreased rejection incidence and improved graft survival.

Conclusions:

  • Kidney transplant outcomes have significantly improved over three decades due to evolving immunosuppressive strategies.
  • Focus has shifted from managing acute rejection to addressing chronic rejection and non-immunological complications like cardiovascular disease.
  • Modern immunosuppressive protocols show promise in further enhancing long-term graft survival.