Kidney Transplant Recipients with Functioning Grafts for More than 15 Years A. Celtik, N. Alpay, A. Celik, T.O. Sezer, A. Turkmen, T. Camsari, H. Toz, M.S. Sever, and C. Hoscoskun, on behalf of the Turkish Society of Nephrology Kidney Transplantation Working Group ABSTRACT Background. Renal transplantation is the best renal replacement therapy because it significantly improves patient survival. The developments in transplantation and increasing number of patients with end-stage renal disease (ESRD) have unmasked long-term complications secondary to immunosuppressive drugs and chronic renal failure. Methods and Results. Eighty-six renal transplant recipients with grafts that have functioned more than 15 years were included in the study. This cross-sectional retrospec- tive analysis of demographic, clinical, and laboratory findings was conducted in 3 Turkish transplantation centers. The mean age was 30.4  10.2 years at the time of the transplantation. The mean time between the transplantation and the study was 19.1  3.6 years. At the time of the study, mean creatinine level was 1.52  0.60 mg/dL, 70.09% of the patients displayed glomerular filtration rates 60 mL/min/1.73 m 2 . Urinary protein excretion was 0.57  0.65 g/d. Hypertension and hyperlipidemia were the most common comorbid diseases. Twelve patients had diabetes and 9 cardiovascular disease. Seventeen patients had been diagnosed with skin and 5 with non-skin cancer. Conclusions. As the number of recipients with long-term functioning grafts increases, long-term complications become evident, particularly chronic renal failure. Survivors should be evaluated regularly and treated early for risk factors and complications to improve long-term graft and patient survival. R enal transplantation significantly improves the survival of patients with end-stage renal disease (ESRD). Developments in immunosuppressive therapy have de- creased the rates of acute rejection episodes but not long-term graft survival. The increasing number of patients with ESRD will augment the number with long-term func- tioning allografts. 1 Unfortunately, these patients have risks of complications secondary to immunosuppression and chronic kidney disease (CKD). The aim of the present study was to evaluate the demographic features and long-term complications among transplant patients with grafts surviv- ing more than 15 years. MATERIALS AND METHODS This cross-sectional study was performed in 3 transplantation centers in Turkey, including recipients with grafts that had func- tioned more than 15 years. Each center reviewed patient records to collect retrospectively demographic, clinical, and laboratory data, including those at the time of the last visit. Graft function was evaluated by serum creatinine level and estimated creatinine clearance calculated with the Modification of Diet in Renal Disease formula. 2 Urinary protein excretion was obtained as spot morning urine protein:creatinine ratios that were calculated by dividing the urinary protein by the urine creatinine concentration. All comorbid conditions were recorded carefully by the re- searcher at each center. Patients having a blood pressure 140 mm Hg systolic and 80 mm Hg diastolic or under antihypertensive therapy at the time of the last visit were defined to be hypertensive. From the Division of Nephrology, Department of Internal Medicine (A. Celtik, H.T.), and Department of General Surgery (T.O.S., C.H.), School of Medicine, Ege University, Izmir, Turkey; Division of Nephrology, Department of Internal Medicine (N.A., A.T., M.S.S.), Istanbul School of Medicine, Istanbul University, Fatih, Istanbul; and Division of Nephrology, Department of Internal Medicine (A. Celik, T.C.), School of Medicine, Dokuz Eylul University, Balcova, Izmir, Turkey. Address reprint requests to Aygul Celtik, MD, Division of Nephrology, Department of Internal Medicine, School of Medi- cine, Ege University, 35100 Bornova, Izmir. E-mail: aygul.celtik@ ege.edu.tr 0041-1345/13/$–see front matter © 2013 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.transproceed.2013.02.051 360 Park Avenue South, New York, NY 10010-1710 904 Transplantation Proceedings, 45, 904 –907 (2013)