Are all successful renal transplants really successful?

We previously described a small group of renal transplant recipients consid ered to have successful allografts statistically but who did not benefit cl inically. These were patients in whom the grafts survived greater than 6 mo nths but less than 3 years. This expanded study evaluates 179 consecutive r enal transplant recipients divided into three groups. Group 1 (n = 18), gro up 2 (n = 41), and group 3 (n = 120) have patients with graft survival less than 6 months, between 6 months and 3 years, and greater than 3 years, res pectively. Mean age, cause of renal failure, HLA match, and immunosuppressi ve regimen were not statistically different in any group. The number of acu te rejection episodes, number of hospitalizations, and number and seriousne ss of complications were significantly greater in group 2 patients compared with the other groups. Patients in group 2 experienced five times the numb er of acute rejections (P < 0.0001), three times the number of hospitalizat ions (P < 0.0001), and two times the number of complications (P < 0.0001) c ompared with group 3 patients. In conclusion, those transplant recipients w hose grafts survived longer than 6 months but less than 3 years were the mo st unfortunate. They experienced repeated and serious complications and spe nt many days in the hospital at great expense. A study with more sensitive methods of detecting presensitization might impact on graft performance in the future. (C) 1999 by the National Kidney Foundation, Inc.