Provision of Highly Specialized Aftercare by the Transplant Center Strongly Improves Patient and Allograft Survival in Long-term Follow-up After Kidney Transplantation

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BackgroundDespite rapid medical advancements in the field of transplantation over the last decades, mean kidney allograft survival remained at a standstill. If and to what extent a highly specialized, experienced, and up-to-date aftercare of kidney transplant recipients (KTRs) impacts patient and allograft outcomes in long-term follow-up, however, remains mostly unknown.Material and MethodsWe hypothesized that highly specialized aftercare of KTRs by transplant centers compared to local nephrologists ultimately improves patient and allograft survival. We retrospectively analyzed 1328 KTRs transplanted between 1998 and 2015 with regard to patient and allograft survival. KTRs treated regularly in our transplant center in long-term follow-up were compared with those KTRs followed by local nephrologists and general practitioners only.ResultsIn total 824 KTRs (62.0%) were followed in our transplant center and 504 KTRs (38.0%) were followed by local nephrologists/general practitioners. Multivariate analysis identified 4 independent factors, that were associated with strong adherence to the transplant center provided aftercare: shorter distance to the transplant center (p<0.001), living donation (p<0.001), early registration to the waiting list (p=0.009), and shorter initial hospital stay (p=0.004). No differences were observed for recipient age, recipient sex, and time on dialysis (p>0.05). KTRs followed in our transplant center showed a significantly better patient survival (72.7% vs. 50.4% after 15 years; p=0.001) and death-censored allograft survival (85.0% vs. 64.4% after 15 years; p<0.001) in long-term follow-up compared to KTRs followed by local nephrologists. These differences were equally observed in deceased and living donor KTRs of a first kidney allograft. Retransplant KTRs followed in our transplant center showed superior death-censored allograft survival (p=0.035), but no differences for patient survival.ConclusionsOur data strongly indicate that provision of aftercare by the transplant center is highly associated with superior patient and allograft survival. The observed wide differences may be attributed to highly specialized immunological and infectious screening protocols, careful and critical guidance of immunosuppression, and more comprehensive medical care. Despite long distances, transplant centers, local nephrologists, and health insurances must encourage patients to make use of transplant center provided aftercare.

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