Long-term kidney transplant graft survival-Making progress when most needed

Area of Science:

• Nephrology
• Transplantation Medicine
• Public Health

Background:

• Short-term kidney transplant survival rates are excellent.
• Longer-term outcomes have historically shown limited improvement.
• Significant disparities exist in transplant outcomes among different demographic groups.

Purpose of the Study:

• To evaluate trends in 1-year and 5-year graft survival and half-lives for kidney transplant recipients in the US.
• To assess changes in long-term transplant outcomes over time.
• To identify differential improvements in outcomes among various patient subgroups.

Main Methods:

• Analysis of adult solitary kidney transplants (n=331,216) from the Scientific Registry of Transplant Recipients (SRTR) between 1995 and 2017.
• Evaluation of adjusted hazard of graft failure across different time eras.
• Comparison of median survival times for deceased and living donor kidney transplants.

Main Results:

• The adjusted hazard of graft failure significantly decreased from 0.89 in 2000-2004 to 0.46 in 2014-2017.
• Improvements in graft failure risk were more pronounced for Black recipients, diabetics, and older individuals.
• Median survival for deceased donor transplants increased from 8.2 to 11.7 years, and for living donor transplants from 12.1 to 19.2 years between the earliest and most recent eras.

Conclusions:

• Continuous improvement in long-term kidney transplant outcomes has been observed.
• These advancements are particularly notable in higher-risk subgroups, including Black patients, diabetics, and older recipients.
• The data suggest a narrowing of outcome disparities for disadvantaged populations following kidney transplantation.