TY - JOUR AU - Kirchner, Varvara AU - Gillingham, Kristen AU - Serrano, Oscar AU - Chinnakotla, Srinath AU - Dunn, Ty AU - Finger, Erik AU - Kandaswamy, Raja AU - Ibrahim, Hassan AU - Spong, Richard AU - Payne, William AU - Pruett, Timothy AU - Sutherland, David AU - Najarian, John AU - Matas, Arthur PY - 2021/04/07 Y2 - 2024/03/28 TI - Long-Term Outcomes in 831 Kidney Transplant Recipients with 20 Years of Graft Function JF - Integrative Journal of Medical Sciences JA - Integr J Med Sci VL - 8 IS - SE - RESEARCH ARTICLES DO - 10.15342/ijms.2021.451 UR - https://mbmj.org/index.php/ijms/article/view/451 SP - AB - <p>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) <u>&gt;</u>20 years.&nbsp; For primary LD recipients, 25-year patient survival(PS) was 83%; 35-year, 59%.&nbsp; Their 25-year death-censored graft survival(DCGS) was 89%; 35-year, 72%.&nbsp;&nbsp; DD recipients had lower PS(<em>P</em>&lt;0.01), DCGS(<em>P</em>&lt;0.01).&nbsp; &nbsp;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).&nbsp; Two major causes of DwF were cancer(31%, LD; 31%, DD) and cardiovascular disease(CVD)(19%, LD;17%, DD).&nbsp; Per multivariate analysis(MVA), risk factors for GL after 20 years in pre–calcineurin inhibitor(CNI) era were human leukocyte antigen(HLA) mismatches <u>&gt;</u>3 antigens, pretransplant type 1 diabetes mellitus(DM1); in CNI era, a history of rejection, female gender.&nbsp; New comorbidities after 20 years were common: CVD(13%, non-DM1;18%, DM1), infections(27%, non-DM1;37%, DM1), 20-29 years posttransplant.&nbsp; Cancer after 20 years included: nonmelanotic skin cancer,22%; solid organ,7%; post-transplant lymphoproliferative disease(PTLD),2%.&nbsp; To improve long-term outcomes, clinical trials on prevention, recognition, and treatment of new comorbidities are needed.</p> ER -