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A recently published study -- the largest long-term study of its kind -- brings good news about kidney transplantation.

Conducted by researchers at the Mayo Clinic, the study used protocol biopsies of the transplanted kidney (taken at one and five years after transplantation) to assess the frequency and examine the progression of tissue changes -- particularly fibrosis (scarring), which can ultimately cause transplanted organs to fail.

Transplant Advances Lead to Better Outcomes

The study, which appears in the April 2011 issue of the American Journal of Transplantation, followed -- for at least five years -- 797 patients who received single-kidney transplants between 1998 and 2004.

• Chronic changes were generally mild at one and five years, and were similar in cadaveric and living-donor kidneys.
• The overall prevalence of moderate or severe fibrosis was 13 percent at one year and 17 percent at five years.

The results suggest that advances in renal transplantation immunosuppression have resulted in fewer, less severe, and less progressive chronic tissue changes in the first five post-transplant years than has been reported in the past.

Studies of patients transplanted in the early 1990s showed that most transplanted kidneys developed progressive scarring that eventually led to organ failure.

“These findings fly in the face of everything we’ve come to believe about progressive tissue damage in transplanted kidneys,” says Duke transplant nephrologist Matthew J. Ellis, MD.

“This is the first study in a number of years to look at the issue of fibrosis in this many people, and the data are relevant in showing the progression of damage at one to five years.”

“The key was that biopsies were routinely taken at post-transplant checkups, and those routine biopsies give us information about the natural history of what happens to the kidney tissue after transplant,” says Ellis, adding that “it’s important to note that these biopsies were performed in patients whose kidney function was unchanged according to blood tests. These same results are not necessarily applicable when rising serum creatinine levels indicate decreasing kidney function.”

Ellis also attributes the overall decrease in post-transplant scarring to changes in the types, combinations, and amounts of anti-rejection medications currently used at most U.S. centers.

“Previous studies were conducted when there were older formulations of these drugs,” he says. “Modifying these agents leads to more pristine kidneys at the five-year mark.”

In addition, says Ellis, standard immune-suppression drugs don’t appear to be as toxic or hard on the kidneys as was previously thought. “Duke is involved in many studies of these agents, novel agents, and novel combos of existing anti-rejection drugs,” he says.

Duke’s High-Volume Program Sees Outstanding Results

Established in 1965, Duke’s Kidney Transplant Program has transplanted approximately 1,200 adult and 40 pediatric kidneys since 1999.

Program highlights include:

• 96.1 percent average one-year patient survival rate, 1998-2008
• 92.3 percent average one-year graft survival rate, 1998-2008
• A busy living-donor program -- which recently added a paired exchange program -- with more than 30 percent of patients receiving kidneys from carefully screened living donors
• One of the nation’s most experienced pediatric renal transplant programs, with special expertise in transplanting patients with congenital kidney conditions
• Experience in performing multi-organ transplants, including kidney-pancreas, kidney-heart, kidney-lung, and kidney-liver
• Aggressive management of patients with complex histories and co-morbidities
• Dedicated transplant nephrologists who see patients from pre-transplant evaluations through post-transplant care
• An active clinical trials program that enables patients to participate in studies of new anti-rejection drugs
• Use of single-incision laparoscopic surgery to remove kidneys from living donors -- a technique pioneered at Duke
• A robust basic research program, which seeks to better understand, prevent, and treat chronic renal disease -- and to head off graft loss and chronic rejection