Resumen de Impact of immunosuppression treatment on the improvement in graft survival after deceased donor renal transplantation: a long-term cohort study

Miguel González Molina, Diego Burgos Santamaría, Mercedes Cabello Díaz, Pedro Ruiz Esteban, Manuel A. Rodríguez, Cristina Gutiérrez, Verónica López, Víctor Baena González, Domingo Hernández Marrero

• We analyzed graft half-life and attrition rates in 1045 adult de - ceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a signif - icant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 ( P< 0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was sig - nificantly less pronounced in 1996-2001, indicating better pres - ervation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel re - active antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Mod - ern immunosuppression could have contributed to the improved kidney transplant outcome