The Thirty-Six Year Experience in Kidney Transplantation at Changzheng Hospital.

Between June 1978 and June 2014, 4,199 kidney transplants were performed at the Transplantation Center of PLA, Changzheng Hospital, Second Military Medical University. In our initial practice period (1978-1985), graft and patient survivals were 48.2% and 56.5%, 27.3% and 31.7%, 22.5% and 24.4%, 20.1% and 23.2%, and 16.5% and 20.8%, at 1, 5, 10, 15, and 20 years, respectively. These results improved tremendously after cyclosporine A (1986-1998) was used at our center. The rates of 1-, 5-, 10-, 15-, and 20-year graft and patient survival were 84.3% and 88.5%, 72.3% and 76.7%, 60.4% and 65.4%, 55.1% and 58.2%, and 49.0% and 51.8%, respectively. Tacrolimus (1999-2014) further increased graft survival to 95.1%, 84.4%, 77.1%, and 70.9%, and patient survival to 98.3%, 90.4%, 80.7%, and 73.4%, at 1, 5, 10, and 15 years, respectively. Multivariate Cox analysis suggested that transplant year, delayed graft function, rejection, immunosuppressive regimen, and original disease were independent predictors of graft survival and that poor HLA matching with 5-6 mismatches had an adverse effect on graft survival compared with 1-2 mismatches. The major causes of patient death included infection (38.1%), cardio-cerebral accident (30.2%), and malignancy (16.3%). As one of the pioneer transplant centers in China, our greatest contribution to organ transplantation in China is our self-developed organ preservation solution (HC-A), which has been used in more than 100,000 grafts and for more than 30 years.