Resultaten van niertransplantatie in Leiden, 1966-1994, en prognostische factoren

Evaluating prognostic determinants and results of renal transplantation.

Design

Descriptive study.

Setting

Leiden University Hospital, the Netherlands.

Methods

Follow-up of all 1289 patients who had a kidney transplantation in Leiden University Hospital between March 1966 and December 1994. The following determinants were investigated: age and sex of donors and recipients, HLA matching, type of immunosuppression, presensitisation, presence of diabetes mellitus, and living or post-mortem donor.

Results

Renal transplantation was very successful during the first few years, one-year graft survival dropped to 50 during the second decade and gradually increased to almost 90 during the last years. 5-year and 10-year graft survival were 65 and 50, respectively. The mean age of recipients increased from 32.8 years to 45.7 years, that of donors from 24.9 to 37.9 years. Duration of dialysis before transplantation increased from 19.7 months to 35.7 months. The introduction of cyclosporine and matching on the HLA-DR locus were responsible for better transplantation results. Other favourable prognostic factors were absence of diabetes mellitus, absence of panel reactive antibodies, kidney from a living donor, male donor and donor age between 20 and 50 years.

Conclusion

Both short term and long term results of renal transplantation improved in spite of a strong increase of mean donor age and mean recipient age and an increase of co-morbidity of the recipients. Introduction of HLA-DR matching and cyclosporine immunosuppression contributed to better graft survival.