Background: There is limited information on clinical characteristics and outcomes of kidney transplant recipients (KTRs) with more than 25 years of graft survival.

Methods: We addressed this question in a single center observational study of consecutively transplanted patients with active follow-up at our university hospital as of 07/31/2017.

Results: We identified 112 patients transplanted between 1973 and 1992 (4% of the total 2,749 being actively followed) with a functioning allograft for at least 25 years. The mean post-transplant follow up was 29.8 ± 4.0 years (Figure 1). Mean age at time of transplant was 34 ± 9 years. The majority were male (n= 60, 54%), had glomerulonephritis as the cause of ESRD (n= 58, 52%), and received live donor transplants (n=74, 66%). There were 68 (61%) patients receiving a living related transplant, and 28 (25%) patients receiving an HLA matched transplant including one from identical twin. Overall, 45 (40%) received preemptive transplants and 18 (16%) were retransplants. Mean length of stay at transplant was 21.3 ± 5.3 days. The incidence of biopsy confirmed acute rejection was 19% (n=21). DSA were checked in 90 (80%) of patients. Of these, 17(15%) were positive, predominantly against DQ and DR antigens. The incidence of malignancy was 44% (n=49) non-melanoma skin cancers being the most common cancer (n= 46, 41%), while the incidence of infectious complications was 77% (n=86) mostly represented by UTIs (n=38, 34%). The incidence of hypertension, NODAT, and heart disease was 89%, 20%, and 18%, respectively. At the time of last follow up, mean serum creatinine was 1.4 ± 0.6 mg/dl; only 15% (n=16) were on triple immunosuppression, and 70 patients (63%) were not on a CNI based regimen.

Conclusion: Only 25% of KTR with excellent graft function for more than 25 years had received an HLA matched kidney. At last follow up, nearly 2/3 were on a CNI free regimen and 40-80% had complications led by infections, skin cancers, and acute rejection.

CITATION INFORMATION: Parajuli S., Mandelbrot D., Aziz F., Garg N., Mohamed M., Muth B., Astor B., Djamali A. Characteristics and Outcomes of Kidney Transplant Recipients with More Than 25 Years of a Functioning Graft Am J Transplant. 2017;17 (suppl 3).

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