Introduction: Kidney transplantation is the best treatment for end-stage renal failure. Between 2 and 5% of transplanted grafts are lost each year and only a small percentage survives 20 years. The aim of this study was to determine those factors that may influence very long-term graft survival.

Patients and Methods: 515 patients with a first transplant performed before 01/01/1996. The mean age was 40.5±12.3 years. 334 men and 181 women. Patient characteristics (age, sex, time on dialysis, type of dialysis, primary renal disease), donor characteristics (age, sex, AB HLA incompatibility, DR HLA incompatibility), immunosuppression (azathioprine, cyclosporine and tacrolimus) cold ischemia time, acute tubular necrosis (ATN) or acute rejection (AR) were analyzed.

Results: We had data from 493 patients (95.7%). 358 had lost their graft before age 20, and 135 had a functioning graft. Patients with graft functioning were younger (age of 36.3±10.5 vs 41.9±12.5 years; p<0.001), there were more women (43% vs 31.8%; p=0.013), time on dialysis had been lower (30.4±25.4 vs 38.0±36.3 months; p=0.007) and donor age was higher (32.4±15.5 vs 29.3±12.7 years; p=0.027). There were no differences in other variables. The most frequent causes of graft loss were AR (43 patients, 12%), chronic rejection (107 patients, 29.9%) and death with a functioning graft (139 patients, 38.8%). The most frequent causes of death were cardiovascular disease (48 patients, 41.7%) and cancer (29 patients, 20.9%). The prevalence of skin tumors was higher in the graft functioning group over 20 years (23.7% vs 13.4% p=0.009) but there was no difference in the prevalence of cardiovascular disease or stroke. Among patients with graft >20 years of evolution, they appeared 9.55 tumors/1000 patients/year, compared to 20.8 tumors/1000 patients/year in the group of survival <20 years. There were heart disease 10.7/1000 patients/year between the group of >20 years survival and 40 cardiac diseases/1000 patients/year among those grafts of <20 years, and 4.1 stroke/1000 patients/year in the group> 20 years versus 15 stroke/1000 patients/year in the survival group <20 years. In the multivariate analysis, only age and masculine gender were risk factors for low graft survival.

Conclusion: 27.8% of our patients had graft survival> 20 years. We identify age and gender as factors associated with prognosis. The control of factors associated with the development of tumors or cardiovascular disease can improve results.

CITATION INFORMATION: Jimenez Alvaro S, Marcen Letosa R, Fernandez Rodriguez A, Elias Treviño S, Galeano Alvarez C, Liaño Garcia F. Very Long Term Graft Survival. Forecasts Factors. Am J Transplant. 2017;17 (suppl 3).

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