Long‐Term Renal Allograft Survival in the United States: A Critical Reappraisal

Renal allograft survival has increased tremendously over past decades; this has been mostly attributed to improvements in first‐year survival. This report describes the evolution of renal allograft survival in the United States where a total of 252 910 patients received a single‐organ kidney transplant between 1989 and 2009. Half‐lives were obtained from the Kaplan–Meier and Cox models. Graft half‐life for deceased‐donor transplants was 6.6 years in 1989, increased to 8 years in 1995, then after the year 2000 further increased to 8.8 years by 2005. More significant improvements were made in higher risk transplants like ECD recipients where the half‐lives increased from 3 years in 1989 to 6.4 years in 2005. In low‐risk populations like living‐donor‐recipients half‐life did not change with 11.4 years in 1989 and 11.9 years in 2005. First‐year attrition rates show dramatic improvements across all subgroups; however, attrition rates beyond the first year show only small improvements and are somewhat more evident in black recipients. The significant progress that has occurred over the last two decades in renal transplantation is mostly driven by improvements in short‐term graft survival but long‐term attrition is slowly improving and could lead to bigger advances in the future. One year renal allograft survival has steadily improved over the last two decades, but renal allograft attrition after the first year of transplantation has remained fairly stable with little improvement over the last two decades. See editorial by Segev on page 422.