The years 1963–1983, when 118 patients received transplants at Ullevål Hospital, represent a pioneering period in the history of organ transplantation, before approval of ciclosporin in 1983 made organ transplantation an accepted treatment option throughout the world. In November 1963, when the first transplantation was performed on a patient with subsequent long-term survival, there were very few reports in Europe of allografts with more than a few months' survival.
According to the Norwegian Renal Registry, the median graft survival in recent years is 12 years for a deceased donor kidney transplant and 15 years for a living donor kidney transplant. The increase in graft survival is largely due to the use of calcineurin inhibitors, namely ciclosporin and tacrolimus. It is interesting to note that both donor types are represented among the patients who still had a functioning original transplant at the end of the study after a median observation period of 41.4 years.
Some studies have found that kidneys donated from a living donor are associated with longer patient survival than kidneys from a deceased donor (5), (6–9), while other studies have found no association between patient survival and donor status (5, 6). A study by Gorlén et al. of the 69 first kidney transplant patients at Ullevål Hospital showed that patients with a deceased donor kidney transplant had a higher mortality rate than patients with a kidney from a living donor (5). Our study also found longer median survival among patients who received a kidney from a living donor, but these patients were generally younger than those who received a transplant from a deceased donor, which may explain the longer survival in this group. For patients within the same five-year age group at the time of surgery, the median survival appears to be roughly the same for living and deceased donor transplants (data not shown). However, unlike Gorlén et al., we have not corrected for other variables that may affect survival, such as donor age, dialysis duration, or HLA incompatibility.
The study by Gorlén et al. of some of the same patient cohort showed 55 % and 44 % average survival rates after 10 and 20 years respectively (5). We found an overall median survival rate after 10 and 20 years of 45 % and 29 % respectively (data not shown in the results for 10 years). However, the patients in our study were generally older than the patients in the first published report.
Patient survival in our study is comparable to the findings in the 1977 study by Henari et al. (10), where long-term haemodialysis was compared with kidney transplantation in 200 patients, and the study by Bradley et al. which reported long-term survival in 177 patients who received kidney replacement therapy in the form of haemodialysis as opposed to transplantation (12). Both studies were conducted before the introduction of ciclosporin, and the former did not differentiate between living donor and deceased donor transplant patients.
The causes of renal failure were reported in the medical records as clinical diagnoses without biopsy, with chronic glomerulonephritis, chronic pyelonephritis and polycystic kidney disease being the three most common. Patients with diabetes, which is one of the most common underlying conditions among today's renal failure patients, were not previously offered transplantation.
Arteriosclerosis leading to cardiovascular disease and stroke was registered as the most common cause of death among study participants. The second most common cause was infections leading to sepsis and pneumonia. It is likely that infections are related to immunosuppression. These findings are consistent with other reports (2, 13). Malignancy as a cause of death was somewhat more frequent than in comparable studies. This is assumed to be due to the long observation period and the fact that the patients were followed up into old age.
One of the weaknesses of the study is that not all relevant data were collected. We have not registered how much or what type of immunosuppressive therapy the patients received after 1983. It would have been interesting to include this data in the study. We also did not contact the surviving patients at the end of the study for their subjective assessment of their quality of life following transplantation. We used the data provided in patient records and are aware that this is not always quality assured.
The strength of the study is the complete records for the first 118 transplant patients at Ullevål Hospital after November 1963, in terms of patient and graft survival with a follow-up period of more than 40 years.
Our conclusion is that the results from Ullevål Hospital are comparable with reports from other transplant centres within the same timeframe. Patient survival and graft function must be regarded as satisfactory in relation to contemporaneous treatment options. Some of the patients still had a functioning transplant at the end of the study. We believe that the observed difference in patient survival between living versus deceased donor transplants is largely due to the age range of the patients. Although we did not examine the patients' quality of life, we must assume that this often improved following transplantation, not least because haemodialysis was clearly much more of a burden in times gone by than it is today.