Improved graft survival after renal transplantation in the United States, 1988 to 1996.

Background: The introduction of cyclosporine has resulted in improvement in the short-term outcome of renal transplantation, but its effect on the lon g-term survival of kidney transplants is not known. Methods: We analyzed the influence of demographic characteristics (age, sex , and race), transplant-related variables (living or cadaveric donor, panel -reactive antibody titer, extent of HLA matching, and cold-ischemia time), and post-transplantation variables (presence or absence of acute rejection, delayed graft function, and therapy with mycophenolate mofetil and tacroli mus) on graft survival for all 93,934 renal transplantations performed in t he United States between 1988 and 1996. A regression analysis adjusted for these variables was used to estimate the risk of graft failure within the f irst year and more than one year after transplantation. Results: From 1988 to 1996, the one-year survival rate for grafts from livi ng donors increased from 88.8 to 93.9 percent, and the rate for cadaveric g rafts increased from 75.7 to 87.7 percent. The half-life for grafts from li ving donors increased steadily from 12.7 to 21.6 years, and that for cadave ric grafts increased from 7.9 to 13.8 years. After censoring of data for pa tients who died with functioning grafts, the half-life for grafts from livi ng donors increased from 16.9 years to 35.9 years, and that for cadaveric g rafts increased from 11.0 years to 19.5 years. The average yearly reduction in the relative hazard of graft failure after one year was 4.2 percent for all recipients (P<0.001), 0.4 percent for those who had acute rejection (P =0.57), and 6.3 percent for those who did not have acute rejection (P<0.001 ). Conclusions: Since 1988, there has been a substantial increase in short-ter m and long-term survival of kidney grafts from both living and cadaveric do nors. (N Engl J Med 2000;342:605-12.) (C)2000, Massachusetts Medical Societ y.