Longterm Outcome

Long-term results are measured in many ways. Patient and graft survival rates are the most obvious, but allograft function, quality of life, and growth and development are also important. Compared to dialysis, a successful transplant improves survival. Pediatric death rates for patients on dialysis are 3.8 per 1000 patient years vs 0.4 per 1000 patient years for recipients of a successful transplant.1 Improvements in transplant outcome are largely due to the use of CsA (Fig. 13B.1).6 One and 5 year patient survival in recipients on CsA (vs. those not on CsA) are 100% (vs. 94% and 86%, respectively). Corresponding 1 and 5 year graft survival for recipients on CsA (vs. those not on CsA) are 93% and 77% (vs. 82% and 68%, respectively). In recipients on CsA, donor source has no impact on patient or graft survival. Importantly, USRDS and single center studies show no difference in survival based on transplant age.1,4,5

In decreasing order of frequency, the causes of graft loss include chronic rejection, acute rejection, recurrence of primary disease, death with function, and technical failure. Risk factors for graft loss have been identified.7 For cadaver recipients, risk factors include age of recipient < 2 years, cold storage time > 24 hours, no antibody induction, donor age < 6 years, previous transplant, African American race, and no HLA DR matches. For LD recipients, the only risk factor is delayed graft function in recipients < 1 year old. The majority of recipients (80%) require at least one readmission.6 The mean number of readmissions is 3 and the reasons for readmission are rejection, infection, urologic complications, and dehydration.

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