CHARACTERISTICS OF LONG-TERM RENAL-TRANSPLANT SURVIVORS

Despite the high rates of rejection, allograft failure, and patient de ath in the early years of renal transplantation, some patients have do ne remarkably well. Forty-three (17 living related donor and 26 cadave r donor recipients) such patients with an allograft that functioned fo r 19 years or more (range, 19 to 29 years) were followed up at this ce nter. The patients included 24 men and 19 women, with a mean age at tr ansplantation of 29 years, of whom 39 were white and four were black. At most recent follow-up, the mean daily dose of azathioprine was 104 mg (range, 50 to 175 mg) and that of prednisone was 10 mg (range, 5 to 20 mg). Mean serum creatinine revel was 1.6 mg/dL (range, 0.7 to 5.4 mg/dL). Acute rejection occurred in 14(33%) patients, Nine patients ha d one episode and five patients had two episodes of acute rejection. L ong-term risks to the recipients appeared in the form of coronary arte ry disease in 10 (23%) patients; malignancy in 13(30%) patients, which included nine patients with skin malignancy; and chronic hepatitis C virus (HCV) infection in four patients, two of whom died of complicati ons of liver failure. Other complications included avascular bone necr osis in five patients, which required total hip replacement in two pat ients; hyperlipidemia requiring treatment in 16(37%) patients; posttra nsplantation diabetes mellitus in 10(23%) patients after a median of 1 7.5 years (range, 1 to 23 years); and hypertension in 23 (53%) patient s. There were seven deaths (three of coronary artery disease, two of l iver failure, one each of sepsis and malignancy) and eight graft losse s (five to death with function, two to chronic rejection, and one to f ocal and segmental glomerulosclerosis). Although long-term allograft s uccess results in patients receiving minimal amounts of immunosuppress ion and having good renal function, long-term renal transplant survivo rs are at risk for significant morbidity even in the third decade post transplantation. (C) 1998 by the National Kidney Foundation, Inc.