Late complications after successful renal transplantation

Of the patients treated with renal transplantation in Gothenburg between 1965 and 1972, 128 (38%) eventually had a "successful" transplant, i.e. a well-functioning graft (primary or secondary) beyond the third year after transplantation. The actuarial ten-year survival was 75%, 95% of these patients were well rehabilitated, medically and socially. Slow chronic rejection of the graft was the most common late complication and was responsible for an annual rate of graft loss of about five per cent. Avoiding overtreatment with immunosuppressive drugs, this complication should be met by early retransplantation. Ten out of 17 deaths occurred despite continued good graft function, seven of these being due to arteriosclerotic disease. In patients with continued good transplant function, negative effects of chronic immunosuppression were relatively uncommon: infection and malignancy caused the death of one and two patients, respectively. The only infectious disease seen in increased frequency was Herpes Zoster. This pattern of late complications with a high incidence of arteriosclerotic disease and a low incidence of infectious complications in the late transplantation course is not in accordance with other reports, where the reverse situation has prevailed. This difference might partly be explained by high age of the patients and adherence to a low-dose policy for chronic immunosuppression in our programme.