Hippokratia 2004, 8(2):51-56
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece
Patients with end stage renal disease have poor overall survival compared with age – matched individuals in the general population and even compared with individuals with other chronic illnesses. One of the goals of renal replacement therapy is to provide patients with the life expectancy as near to normal as possible. Renal transplantation is the form of renal replacement therapy that restores the greatest degree of normal renal function and achieves cadaveric graft survival rates 90%, 60-70% and 30-40% in the first, fifth and 10th posttransplant year respectively and reduces the mortality of patients with end stage renal disease, with 81.3% and 62.2% patient survival 5 and 10 years after cadaveric renal transplantation. The main causes of graft loss after the 1st posttransplant year are chronic allograft nephropathy, death with functioning allograft, recurrence of the original disease, and noncompliance.
A renal transplant must be able to sustain a number of injuries in order to be successful in the long – term. Estimates exist of 3% to 5% graft loss and 5% mortality in the first year in the best programs for cadaver transplantation and less for live donor transplantation. After the first posttransplant year the average GFR decline is about 1.2 to 2.5 ml/min. From this point of view allograft failure remains a significant factor for initiating dialysis.