CLINICAL AND TRANSLATIONAL RESEARCH Long-Term Improvement of Deceased Donor Renal Allograft Survival Since 1996: A Single Transplant Center Study Eugenia Sola, 1 Miguel Gonzalez-Molina, 1,3 Mercedes Cabello, 1 Dolores Burgos, 1 Jose Ramos, 2 Cristina Gutierrez, 1 Veronica Lopez, 1 Jorge Soler, 2 Encarnacion de la Vega, 1 and Domingo Hernandez 1 Background. The rate of acute rejection (AR) has decreased significantly, but whether this is associated with improve- ment in long-term graft survival is controversial. Methods. We analyzed 1445 consecutive adult deceased donor kidney transplant recipients from 1985 to 2005, over two periods (1985–1995 vs. 1996 –2005) to compare long-term graft survival. Results. The second period was associated with older donors and recipients and a reduction in AR. A significant increase of 10.1 months at 11 years was seen in death-censored graft survival in 1996 to 2005. For this posttransplant time, graft half-life was 10.8 years in 1985 to 1995, while at this point in the second period 62% of recipients had a functioning graft. The yearly increase in serum creatinine was less pronounced in the latter period (0.05 mg/dL vs. 0.02 mg/dL, P0.01). No difference was found in patient survival. Cox analysis showed that donor age (HR 1.02, P0.001), AR (HR 1.72, P0.001), panel-reactive antibody at transplantation (HR 1.01, P0.001), and serum creatinine at 1 year (HR 2.01, P0.001) had a negative impact on graft outcome. By contrast, the use of mycophenolate mofetil was associated with a 24% reduction in graft loss rate (HR 0.76, P0.05). Conclusion. Long-term graft survival and renal function have improved in renal transplant recipients since 1996. Keywords: Deceased donor kidney transplantation, Graft and patient survival, Kidney function and immunosuppression. (Transplantation 2010;89: 714–720) O ne-year graft survival after renal transplantation has im- proved significantly, but improvement in long-term graft survival is unclear (1). The introduction of cyclosporine (CsA) in the 1980s significantly reduced the incidence of acute rejection (AR), the factor having the greatest negative impact on graft survival (2). It was, therefore, supposed that long-term graft survival would also improve. However, pub- lished data fail to support this, at least unanimously. In fact, recent years have witnessed controversy about the long-term results of renal transplantation in multicenter studies over the period 1988 to 1996 (3–6). For some, both the 1-year graft survival and the projected graft half-life have improved an- nually during the era of CsA (6), whereas for others, the true half-lives showed only marginal improvement in long-term graft survival, except in the case of retransplantation and in African American recipients (3, 7). Between the periods 1985 to 1995 and 1996 to 2005 important changes took place in the field of deceased donor renal transplantation; some positive, like the introduction of immunosuppressive agents that reduced the rates of AR (8, 9), and others negative, such as the rise in donor and recipient age (10). These changes were sufficient to modify, either in one direction or the other, the long-term results of renal transplantation. We undertook an analysis at a single center of long-term deceased donor graft survival after renal trans- plantation and compared the results in terms of graft survival and renal function between the two periods. PATIENTS AND METHODS Study Design and Patient Population This retrospective cohort study was carried out at a sin- gle transplant center. We pooled data from all adult recipients (18 years) who received a primary or repeat deceased donor transplantation from January 1985 to December 2005 at Car- los Haya University Hospital (Malaga, Spain). Patients with a living donor or double transplant (combined kidney- pancreas or kidney-liver) were excluded. A total of 1445 re- Presented, in part, at the AST Congress in Toronto, May 2008 and the ERA- EDTA in Stockholm, May 2008. 1 Division of Nephrology, Carlos Haya University Hospital, Malaga, Spain. 2 Division of Urology (Renal Transplant Unit), Carlos Haya University Hos- pital, Malaga, Spain. 3 Address correspondence to: Miguel Gonzalez-Molina, Ph.D., Division of Nephrology, Hospital Universitario Carlos Haya, Plaza Dr Gutierrez Cal- zada, 29010 Malaga, Spain. E-mail: mgonmol@yahoo.es ES, MC, DB, CG, VL, JS, EV participated in the research design. MGM par- ticipated in the research design, the writing of the manuscript, in the performance of the research and in data analysis. DH participated in the writing of the manuscript and in data analysis. Received 20 October 2009. Revision requested 20 October 2009. Accepted 26 October 2009. Copyright © 2010 by Lippincott Williams & Wilkins ISSN 0041-1337/10/8906-714 DOI: 10.1097/TP.0b013e3181c892dd 714 | www.transplantjournal.com Transplantation • Volume 89, Number 6, March 27, 2010