FACTORS AFFECTING LONG-TERM PATIENT SURVIVAL AFTER FIRST RENAL TRANSPLANT IDENTIFIED IN A 10-YEAR, 5-CENTRE RETROSPECTIVE NATIONAL UK STUDY  

J. F. Medcalf*¹, J. Bankart², J. James¹, on behalf of the. STEPP research group^3
1John Walls Renal Unit, Leicester General Hospital, ²Department of Health Sciences, University of Leicester, LEICESTER, ³United Kingdom

Introduction: Long-term renal graft survival has progressively improved over the last 15 years but more slowly than improvements in acute rejection. This long term transplant outcome study will collect detailed information on 3000 first renal transplant recipients.
Aims: This is a presentation of patient 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 death unless they transferred out of the unit and did not return. Univariable analysis was initially performed using Log-Rank tests. Factors significantly affecting graft survival were then included in a Cox multivariable analysis.
Results: 2176 patients had sufficient data for this analysis, 563 (26%) of whom had died. Mean age at transplant 44.4 (SD=14.4). 1094 were transplanted 1992-1996, 1082 were transplanted 1997-2001. Ethnic group was known in 1696 (1455 white, 241 non-white), age at Transplant in 2175(1367 Male, 808 Female), and cause of ERF in 2045 (195 DM, 1850 other cause).
Univariable analysis showed differences in patient survival between transplant centres (p<0.0001), year of transplant (1997-2001 survival > 1992-1996, p=0.0001), donor type (live survival > cadaver, p<0.0001), age at transplant (p<0.0001), diabetes as the cause of ERF (p<0.0001), and time on dialysis (longer time giving worse survival p<0.0001). Multivariable analysis showed that older recipient age at transplant, diabetes as cause of ERF, longer time on dialysis pre-transplant, 1992-1996 time cohort, and certain sites predict worse patient survival.
Conclusions: There were significant patient 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.