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Effect of primary diseases

Yasuro Futagawa1, Paul I Terasaki

  • 1Terasaki Foundation Laboratory, Los Angeles, California, USA.

Clinical Transplants
|September 25, 2004
PubMed

Insights

Kidney transplant outcomes have improved with newer immunosuppressants like Tacrolimus-MMF, but patient factors such as race and specific diseases (e.g., IDDM) still impact graft survival rates. Early complications like non-function and rejection significantly reduce long-term success.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Clinical Epidemiology

Background:

  • Trends in kidney transplantation reveal shifts in patient demographics and disease prevalence, including an increase in recipients with diabetes mellitus (IDDM) and hypertension (HTN).
  • Waiting times for dialysis have lengthened, and the average age of transplant candidates has risen.
  • While overall transfusion rates have decreased, certain conditions like Systemic Lupus Erythematosus (SLE) show less reduction.

Purpose of the Study:

  • To analyze trends in kidney transplant patient characteristics, disease etiologies, and outcomes.
  • To evaluate the impact of different immunosuppressive regimens on long-term graft survival.
  • To identify factors influencing graft survival, including patient demographics, disease recurrence, and early post-transplant complications.

Main Methods:

  • Retrospective analysis of a kidney transplant recipient cohort.
  • Comparison of graft survival rates across various disease etiologies, immunosuppressive strategies, and demographic groups.
  • Statistical evaluation of the influence of pre-transplant conditions and early post-operative events on long-term graft function.

Main Results:

  • Tacrolimus-MMF and Neoral-MMF regimens demonstrated superior 5-year graft survival compared to CsA-AZ.
  • Patients with systemic diseases (SLE, IDDM) and certain primary diseases (FGS, IgA, CGN) exhibited higher recurrence rates and lower graft survival.
  • Black recipients had lower graft survival rates than other racial/ethnic groups. Early complications like first-day non-function and need for dialysis significantly reduced graft survival.

Conclusions:

  • Modern immunosuppressive therapies have improved kidney transplant outcomes, yet disparities persist based on race and underlying disease.
  • Early graft dysfunction and rejection are critical predictors of long-term graft failure.
  • Further research is needed to address racial disparities and optimize management for high-risk patient populations, such as those with IDDM and HTN.

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