Why do kidney grafts fail?A long-term single-center experience.

Chronic allograft failure remains the main problem limiting long-term success after kidney transplantation. The aim of this retrospective analysis was to define clinical and histological parameters associated with favorable or poor 10-year outcome. To compare outcome we defined two groups of cadaveric-allograft recipients: a good-outcome group (GOG), composed of 145 cadaveric-kidney recipients who had lived with a functioning graft for at least 10 years and who were either still alive or had died with the functioning graft, and a poor-outcome group (POG) consisting of 86 cadaveric-kidney recipients who had had a functioning graft for at least 1 year and had returned to dialysis between 1 and 10 years after transplantation. The following factors were found to be statistically significant indicators of poor outcome: advanced donor age ( P=0.0001); a first biopsy-proven acute rejection episode within the 1st year ( P<0.0001); more than one acute rejection episode within the 1st year ( P<0.0001); acute vascular rejection, especially if occurring after the 3rd month ( P<0.0001); chronic sclerosing rejection ( P<0.0001); glomerulonephritis in the graft ( P=0.0001); and non-compliance and suboptimal medical treatment (15% of the POG). The mean plasma creatinine and mean urine protein-to-creatinine ratios were significantly lower at 1 month and 1 year in the GOG. In conclusion, advanced donor age, acute rejection episodes with vascular involvement, chronic sclerosing rejection, non-compliance, and suboptimal medical treatment are strong predictors of a poor long-term outcome. The plasma creatinine and protein-to-creatinine ratios at 1 year are the best predictors of good or poor long-term outcome.