Nephrology Dialysis Transplantation, Vol 12, Issue 8 1672-1679, Copyright © 1997 by Oxford University Press
S Arent, M Mallat, R Westendorp, F van der Woude and L van Es
Background: The determinators of patient survival
after renal transplantation are incompletely known, and conflicting results
hae been reported. This may have been influenced by time-related changes in
patients selection, post-transplantation management and immunosuppressive
regimens. This study was performed to evaluate in recipients of a first
renal transplant the effect of patient characteristics, transplantation
era, and the immunosuppressive regimen on patient survival.
Method: We studied data from the Leiden Renal
Transplant Database of all first renal transplantations performed between
1966 and 1994 in Leiden, the Netherlands. The effect of the following
parameters on mortality was investigated: era of transplantation, sex, age
at transplantation, cause of renal failure, immunosuppressive regimen, type
and duration of pretransplantation dialysis, hypertension, diabetes
mellitus, and smoking. In addition we analysed the causes of death. Results
were expressed as crude mortality rates, relative risks of mortality, and
standardized mortality ratios as compared with death rates in the Dutch
population. Results: The analysis comprised 86 living
donor transplant recipients and 916 cadaver transplant recipients. After
adjustment for age and sex, the relative risk of morality for living donor
transplant recipients compared with cadaver transplant recipients was 0.5
(95% CI 0.2 to 10.3, P=0.06). In the first cadaver kidney transplant
recipients the risk of first-year mortality improved significantly with
time, which coincided with the introduction of cyclosporin. The risk of
mortality after the first year was higher in patients aged over 40 years at
transplantation, men, smokers, and in the presence of hypertension or
diabetes, but the effect of individual factors on mortality was small. We
found no effect of the type of pretransplantation dialysis or the duration
of pretransplantation haemodialysis on post-transplantation mortality. The
standardized mortality ratio for recipients of first renal transplants was
14 times the population average in the first year after transplantation and
was still four times in the remaining years.
Conclusion: In the present study, time-related changes
in patient management were responsible for improved patient survival in the
first year after transplantation during the study period. Many individual
factors contributed moderately to the risk of mortality after the first
year. Compared to the general population the mortality rate of renal
transplant recipients was significantly higher during the whole follow-up
period. Keywords: age; azathiprine; cyclosporin;
diabetes mellitus; dialysis; era; hypertension; immunosuppression; renal
transplantation; survival analysis
ORIGINAL ARTICLES
Patient survival after renal transplantation; more than 25 years follow-up
Departments of Clinical Epidemiology and Nephrology, University Hospital of Leiden, Building 1, C3-P, PO Box 9600, 2300 RC Leiden, The Netherlands
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