Kidney transplantation 1-year survival rate

The introduction of CSA signiflcantly improved the outcomes of transplantation. Since its approval and widespread use, patient and graft survival rates have improved secondary to a lower incidence of acute rejection episodes and severe infectious complications. In heart transplant recipients, for example, 1 -year survival rates increased from 56% to 85%, and 5-year survival rates increased from 31% to 15%P The efficacy of CSA is well established in aU types of solid-organ transplants. Currently, CSA is approved for use in kidney, liver, and heart transplantation. 

For a fragile, medically intractable individnal, liver, renal, or combined liver-kidney transplantation may be considered [102-108]. Transplantation is not a cure as it only partially corrects the enzymatic defect, but may result in improved metabolic stability, neurologic function, and quality of life [19, 47, 63, 109-115]. Liver transplantation has also been shown to improve cardiomyopathy [44,116], Dietary therapy, perhaps liberalized, and carnitine supplementation are continued following transplantation [102, 105, 107, 109, 117]. Neurologic dysfunction, including metabolic stroke, and renal disease are not always prevented with transplantation [7, 11, 13, 19, 47, 118, 119], One-year survival rate following transplant was 72.2 % in a multisite, retrospective study of 12 individuals with PROP [47,110]. 

The first successful kidney transplant was performed in 1954 between monozygotic twins, followed by the first attempted liver transplant in 1963 (Starzl et al. 1963). However, significant intraoperative and early postoperative mortality, combined with ineffective and often toxic immunosuppressive regimes, resulted in 1-year survival rates in the 1970s of only 30%. The introduction of effective immunosuppression with cyclosporin in 1981 and subsequently tacrolimus in 1989, led to significant improvement in survival following liver transplantation, and a dramatic increase in the number of transplants being performed. 

Clinical experience following kidney transplantation suggests that primary prophylaxis with tacrolimus results in 1-year graft and patient survival rates that are equivalent to those achieved with Cy A therapy, although with lower rates of acute rejection episodes.Five-year follow-up data suggest improved graft survival with tacrolimus compared with Cy A. Nephrotoxicity, hypertension, and posttransplant diabetes mellitus may occur and v/ere reported commonly in the early studies. ... 

A multicenter randomized comparative trial of tacrolimus in combination with azathioprine or mycofenolate mofetU (MMF) versus cyclosporin (microemulsion) with MMF after cadaveric kidney transplantation demonstrated that all regimens yielded similar acute rejection and graft survival rates at 1 year. The tacrolimus-MMF regimen was associated with the lowest rate of steroid-resistant rejection requiring antilymphocyte therapy. In addition, the tacrolimus-treated patients had lower incidence of hyperlipidemia, a side effect of particular concern in these patients [60]. 

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