Long-Term Outcomes in 831 Kidney Transplant Recipients with 20 Years of Graft Function


Kidney transplantion
long-term outcomes
cardiovascular disease


How to Cite

Kirchner V, Gillingham K, Serrano O, Chinnakotla S, Dunn T, Finger E, Kandaswamy R, Ibrahim H, Spong R, Payne W, Pruett T, Sutherland D, Najarian J, Matas A. Long-Term Outcomes in 831 Kidney Transplant Recipients with 20 Years of Graft Function. Integr J Med Sci [Internet]. 2021 Apr. 7 [cited 2024 Jun. 15];8. Available from: https://mbmj.org/index.php/ijms/article/view/451


An understanding of long-term outcomes for kidney transplant(KTx) recipients who survive with graft function beyond a specific time posttransplant is the first step in creating protocols to optimize care for current and improve outcomes for future recipients. We studied 831KTx recipients-580 living donor(LD); 251 deceased donor(DD)—with graft survival(GS) >20 years.  For primary LD recipients, 25-year patient survival(PS) was 83%; 35-year, 59%.  Their 25-year death-censored graft survival(DCGS) was 89%; 35-year, 72%.   DD recipients had lower PS(P<0.01), DCGS(P<0.01).   After 20 years, two major causes of graft loss(GL) were death with function(DwF)(58%, LD; 58%, DD) and interstitial fibrosis and tubular atrophy(IFTA)(22%, LD; 23%, DD).  Two major causes of DwF were cancer(31%, LD; 31%, DD) and cardiovascular disease(CVD)(19%, LD;17%, DD).  Per multivariate analysis(MVA), risk factors for GL after 20 years in pre–calcineurin inhibitor(CNI) era were human leukocyte antigen(HLA) mismatches >3 antigens, pretransplant type 1 diabetes mellitus(DM1); in CNI era, a history of rejection, female gender.  New comorbidities after 20 years were common: CVD(13%, non-DM1;18%, DM1), infections(27%, non-DM1;37%, DM1), 20-29 years posttransplant.  Cancer after 20 years included: nonmelanotic skin cancer,22%; solid organ,7%; post-transplant lymphoproliferative disease(PTLD),2%.  To improve long-term outcomes, clinical trials on prevention, recognition, and treatment of new comorbidities are needed.



Matas AJ, Humar A, Gillingham KJ, Payne WD, Gruessner RW, Kandaswamy R, et al. Five preventable causes of kidney graft loss in the 1990s: a single-center analysis. Kidney Int. 2002 Aug;62(2):704-14. https://doi.org/10.1046/j.1523-1755.2002.00491.x

Matas AJ, Gillingham KJ, Humar A, Kandaswamy R, Sutherland DE, Payne WD, et al. 2202 kidney transplant recipients with 10 years of graft function: what happens next? Am J Transplant. 2008 Nov;8(11):2410-9. https://doi.org/10.1111/j.1600-6143.2008.02414.x

Lamb KE, Lodhi S, Meier-Kriesche HU. Long-term renal allograft survival in the United States: a critical reappraisal. Am J Transplant. 2011 Mar;11(3):450-62. https://doi.org/10.1111/j.1600-6143.2010.03283.x

Chapman JR. What are the key challenges we face in kidney transplantation today? Transplant Res. 2013 Nov 20;2(Suppl 1):S1. https://doi.org/10.1186/2047-1440-2-s1-s1

Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000 Jan;57(1):307-13. https://doi.org/10.1046/j.1523-1755.2000.00816.x

Bererhi L, Pallet N, Zuber J, Anglicheau D, Kreis H, Legendre C, et al. Clinical and immunological features of very long-term survivors with a single renal transplant. Transpl Int. 2012 May;25(5):545-54. https://doi.org/10.1111/j.1432-2277.2012.01451.x

Traynor C, Jenkinson A, Williams Y, O'Kelly P, Hickey D, Denton M, et al. Twenty-year survivors of kidney transplantation. Am J Transplant. 2012 Dec;12(12):3289-95. https://doi.org/10.1111/j.1600-6143.2012.04236.x

McCaughan JA, Courtney AE. The clinical course of kidney transplant recipients after 20 years of graft function. Am J Transplant. 2015 Mar;15(3):734-40. https://doi.org/10.1111/ajt.13041

Matas AJ, Sutherland DE, Najarian JS. Evolution of immunosuppression at the University of Minnesota. Transplant Proc. 2004 Mar;36(2 Suppl):64S-70S. https://doi.org/10.1016/j.transproceed.2004.01.062

Braun WE, Popowniak KL, Nakamoto S, Gifford RW Jr, Straffon RA. The fate of renal allografts functioning for a minimum of 20 years (level 5A)--indefinite success or beginning of the end? A proposed classification of long-term allograft survivals. Transplantation. 1995 Oct 27;60(8):784-90.

Braun WE, Avery R, Gifford RW Jr, Straffon RA. Straffon, Life after 20 years with a kidney transplant: redefined disease profiles and an emerging nondiabetic vasculopathy. Transplant Proc. Feb-Mar 1997;29(1-2):247-9. https://doi.org/10.1016/s0041-1345(96)00082-6

Younossi ZM, Braun WE, Protiva DA, Gifford RW Jr, Straffon RA. Chronic viral hepatitis in renal transplant recipients with allografts functioning for more than 20 years. Transplantation. 1999 Jan 27;67(2):272-5. https://doi.org/10.1097/00007890-199901270-00015

Braun WE, Richmond BJ, Protiva DA, Gifford RW Jr, Straffon RA. The incidence and management of osteoporosis, gout, and avascular necrosis in recipients of renal allografts functioning more than 20 years (level 5A) treated with prednisone and azathioprine. Transplant Proc. 1999 Feb-Mar;31(1-2):1366-9. https://doi.org/10.1016/s0041-1345(98)02031-4

Peddi VR, Whiting J, Weiskittel PD, Alexander JW, First MR. Characteristics of long-term renal transplant survivors. Am J Kidney Dis. 1998 Jul;32(1):101-6. https://doi.org/10.1053/ajkd.1998.v32.pm9669430

Braun WE, Protiva DA. Emerging profiles in 105 recipients of renal allografts functioning for 20 to 35 years: the "watershed" effect. Transplant Proc. Feb-Mar 2001;33(1-2):1131-3. https://doi.org/10.1016/s0041-1345(00)02460-x

Kyllönen L, Koskimies S, Salmela K. Renal transplant recipients with graft survival longer than 20 years: report on 107 cases. Transplant Proc. 2001 Jun;33(4):2444-5. https://doi.org/10.1016/s0041-1345(01)02039-5

Gaston RS, Cecka JM, Kasiske BL, Fieberg AM, Leduc R, Cosio FC, et al. Evidence for antibody-mediated injury as a major determinant of late kidney allograft failure. Transplantation. 2010 Jul 15;90(1):68-74. https://doi.org/10.1097/tp.0b013e3181e065de

Kasiske BL, Chakkera HA, Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol. 2000 Sep;11(9):1735-1743. https://doi.org/10.1681/asn.v1191735

Ducloux D, Kazory A, Chalopin JM. Predicting coronary heart disease in renal transplant recipients: a prospective study. Kidney Int. 2004 Jul;66(1):441-7. https://doi.org/10.1111/j.1523-1755.2004.00751.x

Wong G, Chapman JR, Craig JC. Cancer screening in renal transplant recipients: what is the evidence? Clin J Am Soc Nephrol. 2008 Mar;3 Suppl 2(Suppl 2):S87-S100. https://doi.org/10.2215/cjn.03320807

Vajdic CM, van Leeuwen MT. Cancer incidence and risk factors after solid organ transplantation. Int J Cancer. 2009 Oct 15;125(8):1747-54. https://doi.org/10.1002/ijc.24439

Holdaas H, Fellström B, Jardine AG, Holme I, Nyberg G, Fauchald P, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet. 2003 Jun 14;361(9374):2024-31.https://doi.org/10.1016/s0140-6736(03)13638-0

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