Causes of renal allograft loss: progress in the 1980s, challenges for the 1990s

Over the past 10 years, the care of the kidney transplant patient has been modified. This modification has included changes in drugs used to suppress graft rejection, treatment and prevention of infections, indications for transplant and modifications of the surgical technique, and improvements in anesthesia and intensive care. A study was undertaken at one hospital to evaluate the effect of these changes on both the rate and cause of rejection of the transplanted kidney. Outcomes of patients treated during the 1970s and those treated during the 1980s were compared. During the 1970s there were 1,012 patients who received kidneys; in the 1980s 1,384. There were 355 recipients who were diabetic in the 1970s and 628 diabetic recipients in the 1980s. The source of the kidney was a living donor for 617 of the 1970s patients and for 740 of the 1980s patients. Overall patient survival increased significantly. At one year, patient survival was 94 percent in the 1980s, compared with 86 percent in the 1970s; five-year survival was 84 percent versus 69 percent; 10-year survival was 68 percent versus 57 percent. Survival of the transplanted kidney also increased during the 1980s. These increases in occurred in spite of a higher percentage of recipients who were diabetic and who received a cadaver organ. The gains observed in the 1980s in graft survival were due mainly to a lower incidence of acute organ rejection and fewer infections. The two leading causes of poor outcomes, chronic rejection and death due to cardiovascular (heart and blood-vessel problems), showed little if any improvement. These are the two areas of challenge for the 1990s. (Consumer Summary produced by Reliance Medical Information, Inc.)