Outcomes after renal transplantation

Outcomes after renal transplantation

Patient and graft survivals vary according to donor type and are presented in Table 88.4 . Overall, kidney transplantation is a highly successful treatment for ESRD. Living donor trans - plants yield better results than deceased donor transplants. Causes of long-term graft dysfunction /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF DBD and DCD kidney transplants have comparable patient and graft survival. Although these survival analyses are helpful, most patients want to know how long their transplant can be expected to last. This is best expressed by graft half-life ( t ) data (median ½ graft survival). The current overall t for live donor transplants ½ is approximately 25 years and for deceased donor transplants approximately 15 years. For all types of kidney , increasing donor age is the most important risk factor for poorer graft survival. Long cold isch aemic time (>12 hours for DCD kidneys and >24 hours for DBD kidneys) is also associated with reduced graft survival. Graft survival also decr eases as the number of HLA mis matches increases.

Immunological Chronic AMR Acute CMR or AMR, which can occur at any time Non-immunological Pre-existing damage in the donor kidney (especially relevant to DCD and extended criteria donor kidneys) Early ischaemia–reperfusion injury Chronic calcineurin nephrotoxicity Ureteric or bladder out /f_l ow obstruction Recurrent urinary tract infection or pyelonephritis BK polyomavirus nephropathy Recurrent native disease: glomerulonephritis; focal segmental glomerulosclerosis; immunoglobulin A nephropathy Renal artery stenosis Poorly controlled hypertension Dyslipidaemia transplantation. 10-year 5-year 10-year 5-year Type of graft graft patient patient allograft survival survival survival survival (donor source) Live donor 95% 90% 90% 80% Deceased 90% 80% 85% 75% donor Deceased donor includes both DBD and DCD results, which are comparable.