WC YEUNG1,2,3, SV BADVE1,2,3, E PASCOE4, CM HAWLEY4,5,6, PA CLAYTON7,8, SP MCDONALD7,8, WH LIM9, G WONG10,11, SJ CHADBAN12,13, SB CAMPBELL4,5,6, and DW JOHNSON4,5,6.
1Department of Renal Medicine, St. George Hospital, Sydney, Australia; 2Renal and Metabolic Division, The George Institute for Global Health, Sydney, Australia; 3School of Medicine, University of New South Wales, Sydney, Australia; 4Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; 5Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; 6Translational Research Institute, Brisbane, Australia; 7The Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; 8Central Northern Adelaide Renal and Transplantation Service, School of Medicine, University of Adelaide, Adelaide, Australia; 9Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; 10Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia; 11School of Public Health, University of Sydney, Sydney, Australia; 12Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia; 13Kidney Node, Charles Perkins Centre, University of Sydney, Australia.
Aim: To evaluate temporal trends in clinical outcomes of kidney transplantation using data from the ANZDATA Registry.
Background: In recent years, there have been substantial changes in the practice of kidney transplantation including medical and surgical advances, and donor and recipient selection. Long-term kidney graft and patient survival in the recent era have not been systematically studied.
Methods: This longitudinal study included all 11,512 children and adults who underwent first living or deceased donor kidney transplant surgery in Australia and New Zealand between January 1, 1996 and December 31, 2013. Trends in all-cause graft loss and patient death across the three transplant eras (era 1: 1996-2001, era 2: 2002-2007, and era 3: 2008-2013) were estimated using time-to-event analysis techniques.
Results: Compared to cohort 1996-2001, patients in cohorts 2002-2007 and 2008-2013 were more likely to be older; have diabetes and coronary artery disease; receive kidneys from older donors, circulatory death and expanded criteria donors; have more HLA mismatches; and receive anti-CD25 monoclonal antibody and be treated with tacrolimus and mycophenolate. Over a median follow-up of 7.7 years, 3,774 grafts were lost and 2,360 patients died. Compared to cohort 1996-2001, all-cause graft and patient survival rates were superior in cohorts 2002-2007 and 2008-2013 for deceased-donor transplants, but not for living-donor transplants. A significant interaction between survival time and transplant era was observed. The risks of graft loss and death for deceased-donor transplants in recent cohorts were lower than cohort 1996-2001 at all time-points, except the risk of graft loss at 5-year in cohort 2008-2013.
Conclusions: Long-term graft and patient survival outcomes of kidney transplantation have improved in deceased-donor transplants, but remained unchanged in living-donor transplants.