Characteristics of recipients whose kidney allograft has functioned for more than 20 years

To study the characteristics of, and predictors for, survival in renal transplant recipients with an allograft functioning for more than 20 years.

Of 144 renal transplants done between 1976 and 1985, 31 allografts were still functioning for more than 20 years (range, 21- 28.5 years). The characteristics of the patients and determinants of the outcomes were obtained by reviewing the patients' medical records.

Fourteen patients were treated with cyclosporine, while 17 patients had primary immunosuppression with azathioprine-based regimens. Episodes of acute rejection occurred in 17 patients (58%), 7 of these experienced 2 or more episodes. At most-recent follow-up, the mean serum creatinine level was 132 +/- 44 micromol/L . Four patients were assessed by graft biopsy 15 or more years after the transplant, revealing 2 cases of mild glomerulosclerosis and 2 cases of moderate chronic allograft nephropathy. The most common complication was hypertension (54%). The independent determinants of long-term graft survival were donor age and source, hypertension both before and after renal transplant, and histopathological findings of chronic allograft nephropathy.

Renal transplant offers a near-normal life to patients with end-stage renal disease soon after transplant and for upwards of 20 years and more. We found no significant benefit to cyclosporine-based immunosuppression on long-term graft survival.