Long-term renal allograft survival: Have we made significant progress or is it time to rethink our analytic and therapeutic strategies?

Herwig Ulf Meier-Kriesche, Jesse D. Schold, Bruce Kaplan

    Research output: Contribution to journalArticle

    494 Scopus citations

    Abstract

    Impressive renal allograft survival improvement between 1988 and 1995 has been described using projections of half-lives based on limited actual follow up. We aimed, now with sufficient follow up available to calculate real half-lives. Real half-lives calculated from Kaplan-Meier curves for the overall population as well as subsets of repeat transplants and African Americans recipients were examined. Real half-lives were substantially shorter than projected half-lives. As a whole, half-lives have improved by about 2 years between 1988 and 1995 as compared to the earlier projected 6 years of improvement. The improvement seems to be driven primarily by the improvement in graft survival of re-transplants. First transplants showed a cumulative increase in graft survival of less than 6 months. Projected half-lives are a risky estimation of long-term survival especially when based on short actual follow up. First-transplant survival has only marginally improved during the early years of post transplant follow up while no significant improvement in long-term survival could be detected between 1988 and 1995. Redirection of attention from early endpoints towards the process of long-term graft loss may be necessary to sustain early gains in the long term.

    Original languageEnglish (US)
    Pages (from-to)1289-1295
    Number of pages7
    JournalAmerican Journal of Transplantation
    Volume4
    Issue number8
    DOIs
    StatePublished - Aug 1 2004

    Keywords

    • Era effect
    • Graft survival
    • Half life
    • Kidney transplantation
    • Long term outcomes
    • Projection

    ASJC Scopus subject areas

    • Immunology and Allergy
    • Transplantation
    • Pharmacology (medical)

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