Long-Term Kidney Graft Survival: A Paired Analysis of Contralateral Kidney Transplants From the Same Donors.

BACKGROUND: Long-term kidney graft survival remains a key challenge in transplantation medicine. This study aimed to identify factors associated with prolonged graft function in recipients whose kidney transplants functioned for more than 10 years and to compare their outcomes with those of recipients who received the contralateral kidney from the same deceased donor. METHODS: We conducted a retrospective cohort study including 208 renal transplant recipients who received kidneys from deceased donors. The analysis focused on paired recipients of contralateral kidneys, in whom at least one graft in each donor pair functioned for ≥10 years. RESULTS: Kaplan-Meier analysis demonstrated reduced graft survival in recipients with prior kidney transplantation (P = .010), steroid use (P = .002), coronary artery disease (P = .018), and chronic rejection (P < .001), whereas antiproliferative agent use was associated with improved survival (P < .001). In multivariable Cox regression analysis, chronic rejection (HR 3.23, 95% CI 1.79-5.84), coronary artery disease (HR 1.68, 95% CI 1.04-2.70), and steroid use (HR 1.93, 95% CI 1.15-3.24) were independently associated with an increased risk of graft loss, while antiproliferative agent use was independently associated with improved graft survival (HR 0.37, 95% CI 0.18-0.74). CONCLUSIONS: These findings underscore the importance of coronary artery disease screening and timely treatment in kidney transplant recipients, significance of continued use of antiproliferative agents and highlight the need for novel strategies aimed at reducing chronic graft injury to improve long-term graft survival.