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Introduction
Long-term renal graft survival has progressively improved, but
more slowly than improvements in acute rejection. This long term
transplant outcome study will collect detailed information on 3000
first renal transplant recipients. This is a presentation of graft
survival in those transplanted between 1992 and 2001.
Methods
All patients who had a first renal transplant were identified
in five UK transplant centres. Data pertaining to: transplant
centre, patient age, sex, ethnic group, time on dialysis
pre-transplant, transplant donor type (live/cadaver), year of
transplant (1992-1996/1997-2001) and diabetes as the attributed
cause of renal failure were collected. Patients were considered to
be at risk of graft failure until they died, or until the end of
December 2001 if death had not occurred by this point. 1659
patients were included in the final analysis, 403 (24%) of whom
had experienced graft failure by this time. Univariable analysis
was initially performed using Log-Rank tests. Factors
significantly affecting graft survival were then included in a Cox
multivariable analysis.
Results
2373 patients have been identified to date. Mean age at
transplant 44.3yrs (SD14.4), 1491 Male, 882 Female. 1158 were
transplanted 1992-1997, 1215 were transplanted 1998-2002. Ethnic
gp was known in 1830(1583 white, 247 non-white).
Univariable
analysis showed differences in graft survival between transplant
centres (p=0.001), year of transplant (1997-2001 > 1992-1996,
p=0.003), donor type (live survival > cadaver, p=0.002) and
ethnic group (white > non-white p<0.001). Significant
differences also existed between recipient ages; patients aged
40-49 had significantly better graft survival than either younger
(<40yrs) or older recipients (60yrs).
Multivariable analysis showed that recipient middle age, live
donor type, recipient white ethnic group, 1997-2001 time cohort,
and certain sites predict longer graft survival. There was a
significant interaction between time-on-dialysis and donor age
(p=0.0008), such that at age <30yrs a longer period of time on
dialysis predicted better graft survival, whilst at older ages the
opposite is true.
Conclusion
There were significant graft survival differences in the study
cohort associated with donor and recipient characteristics, and
between centres. Detailed data collected over the next two years
will allow investigation of quality of life, and other patient
reported outcomes, other important donor and recipient
characteristics, treatment, and models of care affecting patient
and graft survival.
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