Graft and Patient Survival

Kidney transplantation is the treatment of choice for patients with end-stage renal disease, providing a survival and quality of life benefit to the recipient over patients on dialysis. While the survival trend for kidney transplant recipients has steadily improved over the years, the rate of death with a functioning renal allograft remains largely unchanged. Donor and recipient selection impacts both recipient and graft survival and the newly introduced longevity matching-based Kidney Allocation System attempts to capture this association. It is interesting to note that while short-term graft survival has improved significantly over the years, long-term graft survival has not seen an equivalent rise. Various factors including subclinical rejection, immunosuppressive toxicity and chronic allograft dysfunction have been implicated. Protocol renal allograft biopsies serve to provide biological and immunological markers of these factors and biopsy endpoints have been shown to be associated with long-term graft survival. We used laboratory and pathology data after transplant to independently develop a late outcome surrogate score providing a prediction model for graft survival following kidney transplantation. Further effort into developing novel biomarkers and quality predictive models of long-term graft survival is needed.