The long-term outcome of renal transplantation. A 10-year follow-up of 765 recipients.

Abstract

INTRODUCTION\n\xa0Renal transplantation is a treatment of choice for patients with end stage renal disease. The main goal of the transplant care is to achieve the best long-term patient survival (PS) and graft survival (GS).\xa0 Objectives:\xa0The impact of various immunosuppression (IS) protocols on PS and GS survival following renal transplantation was investigated.\n\n\nPATIENTS AND METHODS\n\xa0This was a retrospective single center cohort study. 765 consecutive adult renal transplant recipients (RTR) transplanted in 1998-2003. Primary endpoints included PS and GS. Secondary endpoints were graft function determined by estimated GFR and the hospitalization length per patient per year.\n\n\nRESULTS\n\xa0Ten-year PS and GS rates were 88.6% and 78.7% respectively. The intent-to-treat (ITT) group received IS that was changed later, whereas in the group on randomized therapy (ORT) the same IS protocol was maintained during follow-up. ITT group had significantly better PS and GS than ORT group. ITT patients treated with the combination of tacrolimus (TAC) and azathioprine (AZA), cyclosporine (CSA) and AZA or CSA and mycophenolic acid metabolites (MPA) had significantly better PS than TAC and MPA-treated subgroup. The ORT group receiving AZA in any combination also had significantly better PS than MPA-treated individuals.\xa0 Conclusions:\xa0Influence of IS protocols on the long-term outcomes vary depending on patient subpopulations. Therefore, treatment recommendations should be individualized. Considering our results and fact that IS solves the rejection-related problems, but nowadays RTR die from cardiovascular diseases, malignancies or infections, thorough internal follow-up is necessary to improve the long-term outcomes of renal transplantation.