Late renal allograft failure between 1990 and 1998 in Spain: a changing scenario

Our aim was to study time-dependent modifications in the characteristics of renal transplants in Spain during the 1990s and risk factors associated with death-censored graft failure after the first year.

A total of 3,365 adult patients who underwent transplantation in 1990, 1994, and 1998 with a functioning graft after the first year were included.

Ten-year patient and graft survival rates were 82% and 70%. Major modifications between 1990 and 1998 were increases in donor age (32 +/- 15 to 43 +/- 18 years, P<0.0001) and number of HLA mismatches (2.8 +/- 1.2 to 3.2 +/- 1.2, P<0.0001). Acute rejection decreased from 39% to 25% (P<0.0001), and the prevalence recipients with hepatitis C virus decreased from 29% to 10% (P<0.0001). The use of lipid-lowering agents during the first year increased from 6% to 41% (P<0.0001). Projected renal allograft half-life estimate was 15.4 (range, 14.1-16.8) years in 1990 and 17.7 (range, 14.0-21.4) in 1998 (P=0.007). Independent variables associated with graft survival were as follows: recipient age, last panel-reactive antibodies, acute rejection, hepatitis C virus antibodies in the recipient, triglycerides, serum creatinine and proteinuria at 3 months, and the increase of serum creatinine and proteinuria between the 3rd and 12th month. The use of statins during the first year was associated with a decreased risk for graft loss.

Despite worsening of surrogate parameters of renal quality and poorer HLA matching, graft survival improved during the 1990s in Spain.