Long-Term Outcomes and Factors of Impact on Graft Failure after Kidney Transplantation: A Single Center Experience of 1500 Cases

Background: The most effective treatment of end-stage renal disease is kidney transplantation, and the number of kidney transplantations have rapidly grown. We aimed to determine graft survival and functional outcome of 1500 kidney transplant cases in a single center. We also investigated the factors that affect graft failure after kidney transplantation. Methods: We retrospectively reviewed the clinical data of 1500 pairs of donors and subsequent recipients who underwent kidney transplantation in Samsung Medical Center, from February 1995 to January 2012. Results: The mean follow-up period was 2241.5 ± 1609.4 days. 851(56.7%) recipients were male. 62(4.1%) recipients were less than 19 year-old. 11(0.7%) cases were ABO blood group incompatible kidney transplant. Total 535(36%) deceased and 965(64%) living donors were included. Among them, 137 (9.1%) recipients were experienced in graft failure. Most common cause of graft loss was chronic allograft nephropathy. 1 year, 5 year and 10 year graft survival were 98.2% 93.6% and 85.8% (89.1% for living, 80.4% for deceased donor), respectively. The more graft failure was observed in only two recipient groups that were received deceased donor kidneys or experienced rejection episode. Donor age and pretransplant estimated glomerular filtration rate, warm or cold ischemic time, recipient age and body mass index, immunologic factor such as HLA mismatch, immunosuppressive regimen, extended criteria donor kidney, duration of the pretransplant dialysis, and delayed graft function as characterized by the need for dialysis in the first week after transplantation were not associated with the graft survival. Conclusion: In our experience, overall 10 year graft survival after kidney transplantation were 85.8%. This report demonstrated that the type of donor (living or deceased) and history of allograft rejection are the only significant factors affecting graft survival.