Long-term graft and patient survival following receipt of a kidney transplant have been improving since the 1990s, according to the authors of a recently published review.

Among patients who received a deceased-donor transplant, the 10-year graft survival rate increased from 42.3% for patients who received a transplant during 1996-1999 to 53.6% for those who received a transplant from 2008-2011. During these same time intervals, the 10-year patient survival rates increased from 60.5% to 66.9%.

These improvements have occurred despite increases in recipient age, body mass index, frequency of diabetes, length of time on dialysis, and donor age and percentage of donations after circulatory death, as well as a higher proportion of recipients with a previous kidney transplant, Sundaram Hariharan, MD, of the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, and coauthors reported in the New England Journal of Medicine.

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Survival outcomes also improved among recipients of kidneys from living donors. From 1996-1999 to 2008-2011, the 10-year graft survival rates increased from 53.6% to 69.6% and the 10-year patient survival rates increased from 75.3% to 81.3%.

The authors wrote that the observed improvement in long-term outcomes has been attributed to a decrease in clinical acute rejection rates as well as surveillance for viral infections, effective antiviral prophylaxis, and prudent use of paired-exchange transplants for candidates with incompatible living donors.

Dr Hariharan and coauthors examined outcomes from individuals who received kidney transplants during 6 periods: 1996-1999, 2000-2003, 2004-2007, 2008-2011, 2012-2015, and 2016-2019. The total number of transplants from living and deceased donors increased from 45,008 during 1996-1999 to 76,885 during 2016-2019. The increase was due mostly to the number of transplants from deceased donors, which increased from 29,823 during 1996-1999 to 53,139 during 2016-2019. The number of transplants from living donors increased from 15,185 to 23,746 during the same time period.

The authors lauded the December 2020 passage of the Immunosuppressive Drug Coverage for Kidney Transplant Patients Act, which indefinitely extends Medicare coverage of immunosuppressive medications for kidney transplant recipients who do not have other coverage. The authors called the act “a victory that will pave the way toward further improvements in long-term survival.”

What’s more, the COVID-19 pandemic might have positive consequences for the care of kidney transplant recipients, they noted. “A silver lining of the Covid-19 pandemic,” they wrote, “may be the incorporation of telemedicine into routine care to facilitate access to transplantation and post-transplantation care, particularly for older patients and those in underserved and geographically remote communities.”

They concluded, “Improvements in long-term survival after kidney transplantation has been gratifying, despite unfavorable changes in donor and recipient risk factors. Continuation of this trend will require a multipronged approach that addresses coexisting conditions before transplantation, health literacy, access to caregivers, and, especially among racial and ethnic minority and young transplant recipients, adherence to therapy.”


Hariharan S, Israni AK, Danovitch G. Long-term survival after kidney transplantation. N Engl J Med. 2021;385:729-743. doi:10.1056/NEJMra2014530