Progress in Graft Survival Has Slowed

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After 2000, investigators observed a deceleration in short-term improvements in graft survival.
After 2000, investigators observed a deceleration in short-term improvements in graft survival.

Although kidney allograft outcomes have improved significantly over the last 30 years, a recent slowdown in improvements in short-term graft survival in Europe, as in the United States, has researchers concerned.

A team led by Maarten Naesens, MD, of University Hospitals Leuven in Belgium, conducted a cohort study of 108,787 recipients of deceased (brain death) donor kidneys across 21 European countries from 1986 to 2015. From 1986 to 1999, 1-, 5- and 10-year hazard rates for allograft loss after transplantation declined by 64%, 53%, and 45%, respectively. From 2000 to 2015, however, these rates declined by 22%, 47%, and 64%, respectively.

According to Dr Naesens, most of the progress in graft survival occurred from 1986 to 2000. Little advancement has occurred in the last 15 years. Before 2000, improvement in graft survival occurred in the first 5 years after transplantation, whereas after 2000, less improvement occurred. From 1986 to 1995, 75% of kidney transplants still functioned after 5 years. That proportion rose to just 84% from 2006 to 2015.

“Against expectations, the stagnation has nothing to do with the changing profile of donors and recipients, at any rate,” Dr Naesens said in a press release. “On average, they have become older with more concomitant diseases in past years. But even if we take this into account, it doesn't explain why the lifespan of a transplant kidney has stagnated.”

Dr Naesens noted that the medication currently used to prevent kidney rejection dates back to the 1990s. “Our scientific knowledge has, of course, increased in the last 15 years, but this hasn't resulted in better medicines. This means that there is a clear need for innovation when it comes to kidney transplants,” he said.

References

Coemans M, Susal M, Dohler B, et al. Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015. Kidney Int. DOI: 10.1016/j.kint.2018.05.018

Transplanted kidney survives longer. Ku Leuven; July 25, 2018. [news release] 

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