Introduction: Surgical and medical advances have led to considerable improvement in short-term outcomes of kidney transplantation, with 1-year graft and patient survival approaching 100%. However, the relationship between these changes and long-term patient and graft outcomes remains unclear. Methods: This longitudinal study included all children and adults who underwent first living ([LD] N=4596) or deceased ([DD] N=6915) donor kidney transplant surgery in Australia and New Zealand from January 1996 and December 2013. Risk factors for all-cause and death-censored graft loss, and death were analysed by multivariable Cox regression using era at the time of transplantation (1996-1998, 1999-2001, 2002-2004, 2005-2007, 2008-2010 and 2011-2013). Results: Compared to era 1 (1996-1998), patients transplanted in eras 2-6 were more likely to be older; have diabetes and coronary artery disease; receive kidneys from older donors, circulatory death and expanded criteria donors; have more HLA mismatches; and receive anti-CD25 monoclonal antibody and be treated with tacrolimus over cyclosporine and mycophenolate over azathioprine. Over a median follow-up of 6.6 yrs, 1089 LD and 2330 DD grafts were lost and 523 LD and 1581 DD recipients died. Compared to era 1, 5- and 10-year all-cause and death-censored graft survival rates over eras 2-6 improved among both LD and DD transplant recipients (logrank test for trend P<0.001). While 5- and 10-year patient survival rates improved among DD recipients (P<0.001), they remained unchanged among LD recipients (P=0.4). The hazard ratio for graft loss and death after LD and DD kidney transplantation are described in the figure. Conclusion: There have been significant improvements long-term graft and patient survival outcomes in both LD and DD kidney transplant recipients.

CITATION INFORMATION: Lim W, Yeung W.-C, Campbell S, Chadban S, Clayton P, Hawley C, Johnson D, McDonald S, Pascoe E, Wong G, Badve S. Trends in Long-Term Outcomes of Kidney Transplantation in Australia and New Zealand. Am J Transplant. 2017;17 (suppl 3).

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