BOSTON-Short-term and long-term survival following kidney transplantation from either a cadaveric or living donor has steadily improved since 1988, according to a recent study published in The New England Journal of Medicine (2000;342:605-612).
Sundaram Hariharan, MD, of Medical College of Wisconsin, Milwaukee, and colleagues studied all 93,934 kidney transplants performed in the United States between 1988 and 1996. During the study period, one-year survival increased from 88.8% to 93.9% following living-donor kidney transplantation and rose from 75.7% to 87.7% following cadaveric kidney transplantation.
The expected median survival of the grafts increased from 16.9 years to 35.9 years in patients receiving living-donor kidneys, and it increased from 11.0 years to 19.5 years in those receiving cadaveric kidneys. In an editorial in the journal, Charles B. Carpenter, MD, of Brigham and Women's Hospital in Boston pointed out that the improvements could not be "attributable to any of the newer immunosuppressive drugs, because [the study] took place in the era of treatment with cyclosporine, azathioprine, and prednisone" (2000;342:647-648). Dr. Carpenter suggested that possible contributors to the improved survival rates include "better clinical care, including perhaps better treatment of hypertension, more effective treatment or prophylaxis against serious infectious diseases, and an increased use of kidneys from cadaveric donors in HLA-matched recipients."
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