Graft and Patient Survival

Abstract

Kidney transplantation is agreed upon as the best treatment available for most patients with end-stage renal disease (ESRD). It not only improves quality of life (Am J Kidney Dis 15(3):201–8, 1990; Kidney Int 50(1):235–42, 1996; N Engl J Med 28;312(9):553–9, 1985; Transplantation 54(4):656–60, 1992) of our patients and reduces medical expense (Kidney Int 50(1):235–42, 1996; Semin Nephrol 12(3):284–9, 1992) but also has shown to be a life-prolonging procedure. Multiple studies using renal transplant recipients with dialysis patients have found that patient survival is clearly better with renal transplantation than with dialysis (Kidney Int 21(1):78–83, 1982; Transplantation. 60(12):1389–94, 1995; Nephrol Dial Transplant 12(8):1672–9, 1997; Kidney Int 53(3):767–72, 1998).

Dramatic improvements made in the 1-year renal allograft survival over the past 2 decades have shifted attention to long-term graft survival as a more reliable measure of successful transplantation. Despite the recognized limitations of large-scale database retrospective analyses, well-executed studies have identified key risk factors important for long-term patient and graft survival. It is becoming increasingly clear that early transplantation, preservation of optimal renal function, and attempts to decrease CV morbidity and mortality are becoming important goals of new therapeutic strategies. In addition, prevention of recurrent renal disease and BK virus nephropathy are also of greater importance in this era of lowered AR risk. Ultimately, large, prospective, multicentered trials will be necessary to determine whether therapeutic interventions designed to alter these identified risk factors will have the desired effects on long-term graft survival.