Long-term results of solid organ transplantation. Report from the Eurotransplant International Foundation.

Graft survival of cadaveric kidney-only, liver-only and heart-only transplants, performed in the Eurotransplant area between 1987-1990, was analysed, up to 5 years after transplantation. 1. HLA-A,-B,-DR mismatches had a statistically significant adverse influence on renal graft survival. 2. Kidney retransplantation was not found to be associated with a higher risk of graft loss, in contrast to liver and heart retransplantation. 3. The use of non-ideal donors (aged under 16 or over 55, non-head trauma donors) in renal transplantation should be re-evaluated, while elderly donors as well as elderly recipients jeopardized liver and heart transplant success rates. 4. A learning phase in liver and heart transplantation was evident from 1987-1990. 5. Time-effect studies can be used to adopt individual monitoring schemes. A persistent risk of graft loss in renal transplantation was observed for transplants from older donors and transplants in older recipients; these grafts constituted a very vulnerable group. For liver and heart retransplants it was noted that once patients had survived the first postoperative month, their relative risk of graft failure was no longer significantly different from patients with a first transplant. A well-considered long-term monitoring scheme for heart allograft recipients who are over age 55 is justified, as these patients had a higher risk of failure compared with younger patients. The same would be advantageous for liver transplants that are performed because of underlying liver malignancies.