UW study: Kidney transplant outcomes improve significantly over last half-century

MADISON, Wis. – Kidney transplant patients are living longer and transplanted kidneys are lasting longer thanks to advances in patient care, improved immunosuppression strategies and organ preservation techniques, according to a new study by researchers at the University of Wisconsin School of Medicine and Public Health and the UW Health Transplant Center.

In a first-of-its-kind, single-center observational study led by Dr. Sandesh Parajuli, associate medical director of the UW Health Kidney and Pancreas Transplant Programs, the team examined outcomes of 12,000 kidney transplants performed at the UW Health Transplant Center. As one of the few transplant centers in the country to reach this milestone, these data provided a unique glimpse into the evolving landscape of kidney transplantation, according to Parajuli.

“We have made remarkable progress in kidney transplantation outcomes over more than five decades,” said Parajuli, who is also an associate professor of medicine at the UW School of Medicine and Public Health. “Through this research in organ preservation and advancing the medical and surgical care of patients, we are able to provide valuable insight into the transformative journey of kidney transplantation, from its early days to becoming the treatment of choice for end-stage kidney disease patients.”

The study was published in the journal Transplantation Direct.

The UW Health Kidney Transplant Program began when clinicians performed the first adult kidney transplant at UW in 1966, followed by the first pediatric kidney transplant at the hospital in 1967.

Parajuli and his team analyzed kidney transplants in each of the past six decades culminating in 2022. Patients receiving kidney transplants have ranged from less than 1 year old to more than 80 years old. In the first decade of the program, the mean age at transplant was 33 years old. Since 2016, the mean age has risen to 52 years old. This demonstrates the significant progress in pre- and post-transplant care, according to Dr. Didier Mandelbrot, medical director of the UW Health Kidney and Pancreas Transplant Programs, and professor of medicine at UW School of Medicine and Public Health.

“Induction and maintenance immunosuppressive agents have evolved, including highly effective anti-rejection medicines developed here in Madison,” he said. “These medications revolutionized transplant care, enabling older patients to benefit from life-saving procedures once deemed too risky, paving the way for extended and improved quality of life."

Results revealed statistically significant decreases in the risk of patient death, the return to dialysis or need for another transplant, at one year and five years post-transplant, as well as at a patient’s last follow-up visit across all subsequent eras compared to the earliest period analyzed.

Additionally, survival rates of patients and transplanted kidneys improved consistently throughout the study period. Most notable are the improvements in long-term survival in kidney transplantation with 565 patients, or 14%, retaining the same kidney for more than 25 years. Long-term outcomes are where the most progress is needed, with a focus on the prevention and treatment of acute rejection, cardiovascular disease and cancer, according to Dr. Jacqueline Garonzik Wang, surgical director of the UW Health Kidney Transplant Program.

“In caring for this unique group of patients, we gain a fuller understanding of the specific monitoring and management needed to increase their survival,” said Garonzik Wang, who is also an associate professor of surgery at the UW School of Medicine and Public Health. “Those improvements can lead to a better quality of life, longer life expectancy and cost-effectiveness for patients, as well as increase the number of kidneys available to those still waiting for a life-saving transplant.”

In the program’s first decade, 247 kidneys were transplanted. Now the program surpasses that number each year with approximately 300 to 350 kidneys transplanted annually. This increasing volume illustrates a dedication to patient-centered care, according to Dr. Dixon Kaufman, medical director, UW Health Transplant Center, and professor of surgery at the UW School of Medicine and Public Health.

“Kidney transplantation remains a robust and ever-growing and improving field,” he said. “Our entire team’s commitment to putting the patient first, combined with rigorous training programs and comprehensive clinical research initiatives continue to drive advancements that benefit patients across the country.”

This study examined outcomes from a single center and the findings are reflective of a specific population and clinical approach, leading to certain limitations but also valuable insights, according to Parajuli.

“Our program has been a national leader in this field, and we hope these findings inspire and motivate patients and the providers dedicated to the field of transplant,” he said.

The UW Health Kidney Transplant Program includes six adult clinics in Madison, Green Bay, Sparta, Waukesha, Marshfield and Rockford, Ill. There are four pediatric clinics for kidney patients located in Madison, La Crosse, Green Bay and Oshkosh.

Funding for the study was provided by an unrestricted research grant from the Virginia Lee Cook Foundation.