92(8):913-917, October 27th, 2011.
The aim of transplantation is to increase the quality and quantity of life for the recipients. With the increasing success of solid organ transplantation, outcome measures have moved from simply looking at one year survival to 5, 10 and 20 year survival. Indeed, for a child, survival could be considered in terms of 30 or even 50 years. In allograft recipients, survival is limited by many factors, including the legacy of extra-organ disease associated with end-organ failure (such as cardiovascular disease in those with renal failure), the impact of disease recurrence and the consequences of treatment which may be general, such as an increased risk of some cancers and infections, and drug specific disease such as renal failure or diabetes. Allograft recipients are, of course, also at risk of all the other conditions that may affect non-transplanted people. Survival after transplantation is usually very good but not normal, either in quality or quantity, In addition to looking at survival probability, others are looking at life years gained because of the transplant (that is compared with not having a transplant) and comparison with a normal matched population. Those liver recipients, who have survived one year post transplant, will lose, on average, 7 to 8 years compared with a normal age and sex matched control (this loss of life years is probably an underestimate since the most of transplanted population have been selected as being without other diseases). The loss of life years is greatest in the younger and is affected by indication and gender. Here, the Heidelberg group have looked at relative survival gradients in kidney recipients and show that, for a 5 year absolute survival, survival rates are reduced compared with a matched normal population. Information provided will be not only of interest to the transplant community but also the recipients and their families. Thus, while huge advances have been made in improving the lives of countless allograft recipients, there is still much to be done. Provision of such data not only draws attention to this gap but highlights the need to continue to focus on the general health of the recipient as well as the welfare of the graft.
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