Long-Term Survival (>25 Years) of Deceased Donor Kidney Transplant Recipients: A Single-Center Experience

Abstract

Introduction. The aim of this preliminary work is to analyze the clinical features of 52 patients with a functional transplanted kidney for >25 years (all first transplant and all deceased donor recipients) and to compare with a similar though more complete study from Hôpital Necker-Paris 2012. Methods. The mean graft survival at 25 years is 12.7% and at 30 years is 10%. The actual mean serum creatinine concentration is 1.3 mg/L. We analyzed recipient age (mean, 35.9 years) and gender (29 men and 23 women). Donor age was 26.7 AE 10.3 years. Seven patients (13.4%) were transplanted with 1 HLA mismatch, 42.3% with 2 mismatches, and 44.2% with 3 mismatches. Mean cold ischemia time was 15.45 AE 7.7 hours. Of the recipients, 76% had immediate graft function; 38% experienced 1 acute rejection episode and 4 patients had 2 rejection crises. The initial immunosuppressive regimen was azathioprine (AZA) þ prednisolone (Pred) in 14 patients, cyclosporin (CSA) þ Pred in 13 patients, and CSA þ AZA þ Pred in 25 patients. Of these patients, 19% maintained their initial regimen, and 54% (28 patients) were very stable on a mixed CSA regimen for >25 years.Results. We present the major complications (diabetes, neoplasia, and hepatitis C virus positivity). Conclusion. Our results in deceased donor kidney recipients for >25 years are similar to the mixed population (deceased donors and living donors) presented by the Necker group, although 54% of our patients remain on CSA immunosuppression, contradicting the idea that its use is not compatible with good long-term kidney function in transplant recipients.C ONSIDERABLE progress has been made in the care of transplant recipients regarding organ preservation, quality, and quantity for life of these patients. Mainly, improvements in the management of complications allowed the emergence of a group of long-term survivors who were transplanted several decades ago. These patients constitute a unique population about whom few data have been published. The few publications [1e3] of patients with functioning renal allograft for >25 years are usually related to a mixed population of living-related donors (usually the larger percentage) and deceased donor transplant recipients.Our unit performed our first renal transplantation in June 1980. We celebrated our 500th in 1990 and our 1000th procedure in 1997. We selected a group of patients with functioning kidney graft transplanted !20 years ago, all from a deceased donor. The aim of the work was to present and compare the clinical characteristics of this unique population. PATIENTS AND METHODSFrom July 1980 to January 15, 1994 (20 years ago), we performed 759 transplants; of those recipients, 110 maintain a functioning kidney on follow-up, 52 for >25 years and 11 for >30 years. The longest surviving recipient has a 33-year-old, functioning graft. The

Effects of immunotherapy induction on outcome and graft survival of kidney-transplanted patients with different immunological risk of rejection

“…The half-life of graft survival remains approximately 12 years [30]. However, graft survival from living and deceased donors of more than 20 years was demonstrated in transplanted recipients treated with azathioprine monotherapy [31], and long-term graft survival of more than 30 years was also similar between grafts from both types of donors [32]. A recent ultra-long-term graft survival using monotherapy was demonstrated in a patient who lived 42 years with a 100-year-old graft received from a related living donor [33].…”