2,500 living donor kidney transplants: A single-center experience

Objective To review a single center's experience and outcome with living donor transp lants, Summary Background Data Outcome after living donor transplants is better than after cadaver donor t ransplants. Since the inception of the authors' program, they have performe d 2,540 living donor transplants. For the most recent cohort of recipients, improvements in patient care and immunosuppressive protocols have improved outcome. In this review, the authors analyzed outcome in relation to proto col. Methods The authors studied patient and graft survival by decade. For those transpl anted in the 1990s, the impact of immunosuppressive protocol, donor source, diabetes, and preemptive transplantation was analyzed. The incidence of re jection, posttransplant steroid-related complications, and return to work w as determined. Finally, multivariate analysis was used to study risk factor s for worse 1-year graft survival and, for those with graft function at 1 y ear, to study risk factors for worse long-term survival. Results For each decade since 1960, outcome has improved after living donor transpl ants. Compared with patients transplanted in the 1960s, those transplanted in the 1990s have better 8-year actuarial patient and graft survival rates. Death with function and chronic rejection have continued to be a major cau se of graft loss, whereas acute rejection has become a rare cause of graft loss. Cardiovascular deaths have become a more predominant cause of patient death; infection has decreased. Donor source (e.g., ideally HLA-identical sibling) continues to be important. For living donor transplants, rejection and graft survival rates are related to donor source. The authors show tha t patients who had preemptive transplants or less than I year of dialysis h ave better 5-year graft survival and more frequently return to full-time em ployment. Readmission and complications remain problems; of patients transp lanted in the 1990s, only 36% never required readmission. Similarly, steroi d-related complications remain common. The authors' multivariate analysis s hows that the major risk factor for worse 1-year graft survival was delayed graft function, For recipients with 1-year graft survival, risk factors fo r worse long-term outcome were pretransplant smoking, pretransplant periphe ral vascular disease, pretransplant dialysis for more than I year, one or m ore acute rejection episodes, and donor age older than 55. Conclusions These data show that the outcome of living donor transplants has continued to improve. However, for living donors, donor source affects outcome. The a uthors also identify other major risk factors affecting both short- and lon g-term outcome.