Renal transplantation--15 years' experience.

In Australia, it has been logistically possible, with integrated programmes of dialysis and transplantation, to use finite resources optimally for the treatment of patients presenting with terminal renal failure (30 per million population per year). Transplantation is offered as definitive treatment in most instances. Transplantation rates (20 per million per year) will need to increase to meet the continuing demand, if the results of transplantation remain unchanged. Patient survival after transplantation is approximately 80 per cent at year, 50 per cent at 5 years and 20 per cent at 15 years. Most grafts are from cadavers. Graft survival of 60 per cent at 1 year thereafter declines steadily with a 3 per cent graft loss per year. Patient and graft survival are adversely affected by increasing age, and the use of cadaver rather than living donors. Graft survival is superior with a 4 antigen match on HLA A and B matching, and is significantly lower in patients receiving no blood transfusions prior to transplantation. Long term morbidity is significant in two-thirds of patients receiving grafts. Problems include chronic rejection and toxic effects of immunosuppression. The increased tumour risk after transplantation (which in Australia has been mostly skin tumours) is of major concern; 30 per cent of patients by 10 years have developed cancer.