Long-term outlook for renal transplant recipients with one-year function: “doctor, what are my chances?”

Patients with renal transplants that survive the first year often ask about the chance of long-term function. We studied 1850 patients with primary transplants from June 7, 1963 to September 1, 1988 who had graft survival of greater than 1 year. Patients were grouped by donor type, diabetic status, and whether or not they received cyclosporine (CsA). Half-life (T½) was used to compare long-term survival rates. We determined the long-term graft survival inclusive and exclusive of death with function (DwF) in order to study all patients and to direct attention to immunologic losses. Pre-CsA, DwF was the major cause of graft loss in each cohort. Cause of DwF was cardiovascular (49%), infection (26%), and cancer (14%). The percentage of patients experiencing DwF was much higher in the pre-CsA group vs. the CsA group: HLA-identical living related donor, 16% vs. 3%; non-HLA-identical LRD, 22% vs. 5%; and cadaver donors, 26% vs. 11%. T½ for 711 transplants to diabetics (DM) was 9.01±.54 years, while for transplants to 1139 nondiabetics (NDM) T½ was 13.57±.68 (P<.05). When DwF is excluded (DwFex) DM T½ = 23.5±2.69 and NDM T½ = 22.2+1.55 (NS). Overall, for HLA-identical transplants (n=297) T½ = 26.13±3.35 and DwFex T½ = 104.3± 28.93. Nonidentical LRD (n=845) T½ = 11.25±.61 and DwFex T½ = 19.37±1.55. For CAD (n=701) T½ = 9.10±.54 and DwFex T½ = 17.49±1.65. Comparing pre- and post-CsA cohorts, CsA has not resulted in significant improvement in long-term graft survival by T½ analysis with DwFex. It appears that overall long-term graft survival has improved with the introduction of CsA. Much of the improvement may be attributed to better first year graft survival and a reduction in cases of DwF. DM patients have an equal opportunity for long-term graft survival if they do not die from other causes. Excluding DwF, especially as an older population is transplanted, is im-portant in determining chances of immunologic loss. Use of this type of analysis suggests that long-term outlook for 1-year graft survivors is excellent.