Sandesh Parajuli1, Didier A Mandelbrot1, Fahad Aziz1, Neetika Garg1, Brenda Muth1, Maha Mohamed1, Michael J Armbrust1, Brad C Astor1,2, Arjang Djamali1,3. 1. Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. 2. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. 3. Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Abstract
BACKGROUND: Information regarding the clinical characteristics and outcomes of kidney transplant recipients (KTRs) with > 25 years of graft survival is limited. METHODS: In this single-center observational study, we characterized KTRs transplanted between 1973 and 1992 with active follow-up as of July 31, 2017. RESULTS: We identified 112 patients with > 25 years of allograft function. The mean posttransplantation follow-up was 29.8 ± 4.0 years. Glomerulonephritis was the most common cause of end-stage renal disease (ESRD) (52%). The majority received live donor transplants (66%), including 25 patients (22%) with human leukocyte antigen-matched kidneys. The incidence of biopsy-confirmed acute rejection was 21%, ranging from 0 to 26 years post transplantation. Donor-specific antibodies (DSA) were checked in 80% of patients at a mean of 28.4 ± 0.11 years post transplantation. Of these, only 15% were positive. The incidence of malignancy was 44%, with nonmelanoma skin cancers being most common. The incidence of infectious complications was 77%, mostly represented by urinary tract infections. At the time of last follow-up, 63% were on a calcineurin inhibitor (CNI)-free regimen, mean serum creatinine was 1.4 ± 0.6 mg/dL, and the prevalence of hypertension and dyslipidemia was 89 and 88%, respectively. CONCLUSION: The majority of patients with a long-term functioning graft had glomerulonephritis as cause of ESRD, had received a live donor kidney, were on a CNI-free regimen, and had a low incidence of DSA and opportunistic infections. These characteristics define a unique group of patients requiring specific posttransplantation monitoring and management.
BACKGROUND: Information regarding the clinical characteristics and outcomes of kidney transplant recipients (KTRs) with > 25 years of graft survival is limited. METHODS: In this single-center observational study, we characterized KTRs transplanted between 1973 and 1992 with active follow-up as of July 31, 2017. RESULTS: We identified 112 patients with > 25 years of allograft function. The mean posttransplantation follow-up was 29.8 ± 4.0 years. Glomerulonephritis was the most common cause of end-stage renal disease (ESRD) (52%). The majority received live donor transplants (66%), including 25 patients (22%) with human leukocyte antigen-matched kidneys. The incidence of biopsy-confirmed acute rejection was 21%, ranging from 0 to 26 years post transplantation. Donor-specific antibodies (DSA) were checked in 80% of patients at a mean of 28.4 ± 0.11 years post transplantation. Of these, only 15% were positive. The incidence of malignancy was 44%, with nonmelanoma skin cancers being most common. The incidence of infectious complications was 77%, mostly represented by urinary tract infections. At the time of last follow-up, 63% were on a calcineurin inhibitor (CNI)-free regimen, mean serum creatinine was 1.4 ± 0.6 mg/dL, and the prevalence of hypertension and dyslipidemia was 89 and 88%, respectively. CONCLUSION: The majority of patients with a long-term functioning graft had glomerulonephritis as cause of ESRD, had received a live donor kidney, were on a CNI-free regimen, and had a low incidence of DSA and opportunistic infections. These characteristics define a unique group of patients requiring specific posttransplantation monitoring and management.
Authors: Panduranga S Rao; Douglas E Schaubel; Xiaoyu Jia; Shiqian Li; Friedrich K Port; Rajiv Saran Journal: Am J Kidney Dis Date: 2007-02 Impact factor: 8.860
Authors: R A Wolfe; V B Ashby; E L Milford; A O Ojo; R E Ettenger; L Y Agodoa; P J Held; F K Port Journal: N Engl J Med Date: 1999-12-02 Impact factor: 91.245
Authors: Bertram L Kasiske; Shakeel Anjum; Rajiv Shah; Jeffrey Skogen; Chitra Kandaswamy; Barbara Danielson; Eileen A O'Shaughnessy; David C Dahl; John R Silkensen; Meena Sahadevan; Jon J Snyder Journal: Am J Kidney Dis Date: 2004-06 Impact factor: 8.860