Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015

Abstract

The evolution of kidney allograft survival remains insufficiently studied in the context of the changing donor and recipient demographics. Since European data are lacking we performed a cohort study (1986-2015) that, based on the Collaborative Transplant Study, included 108 787 recipients of brain-death kidney donors in 135 hospitals across 21 European countries. We analyzed the hazard rate of kidney failure after transplantation. Between 1986 and 1999, improvement in graft survival was more pronounced in the short term than in the long term: one-, five- and ten-year hazard rates after transplantation declined 64% (95% confidence interval, 61%-66%), 53% (49%-57%) and 45% (39%-50%), respectively. Between 2000 and 2015, hazard rates at one, five and ten years post-transplant declined respectively 22% (12-30%), 47% (36-56%) and 64% (45-76%). Improvement in graft survival in the first five years post-transplant was significantly less since 2000, while improvement after five years was comparable to before. During the 2000-2015 period improvement of graft survival was greater in the long than in the short term. These changes were independent of changing donor and recipient characteristics, and reflect the evolution in global kidney transplant management over the past decades. Unfortunately, after accounting for the evolution of donor and recipient characteristics, we found that short-term improvement in graft survival decreased since 2000, while long-term improvement remained unchanged in Europe. Thus, deceleration of short-term graft survival improvement in more recent years illustrates an unmet need for innovation.

Progressive improvement in short‐, medium‐ and long‐term graft survival in kidney transplantation patients in Ireland – a retrospective study

“…Factors which associated with graft failure from multivariable models in the Irish program included older era of transplant, increasing donor age, donor sex and cold ischaemia time (Table ). These findings were consistent with the larger CTS study across Europe . Half‐life estimations of graft survival performed by CTS, based on observed death‐censored graft failure rates in Ireland, also indicated continued improvement in long‐term graft survival (Table ).…”

“…However the authors specify that while the improvements in the first 5 years post transplant have decreased since the year 2000, improvements after 5 years did not appear to plateau . As a result, the improvements in long‐term function were greater than short‐term improvements from 2000 to 2015 . This study provides good evidence of generalized improvements across the European region as a whole gleaned from a larger diverse composite cohort.…”

“…A recent CTS study assessed trends in graft failure across 21 countries, and 135 transplant centers in Europe between 1986 and 2015 . This study found an improvement in the hazard of graft failure at 1, 5 and 10 years post transplant over this period.…”

“…This study found an improvement in the hazard of graft failure at 1, 5 and 10 years post transplant over this period. However the authors specify that while the improvements in the first 5 years post transplant have decreased since the year 2000, improvements after 5 years did not appear to plateau . As a result, the improvements in long‐term function were greater than short‐term improvements from 2000 to 2015 .…”

Effect of donor nephrectomy time during circulatory-dead donor kidney retrieval on transplant graft failure

“…Kidney transplantation is the treatment of choice for patients with end‐stage renal disease, improving survival and quality of life. Despite all efforts in recent decades, long‐term outcome has not improved. One factor with a negative influence on transplant outcome is ischaemia–reperfusion injury of the graft, an inevitable problem during organ transplantation.…”