Kidney graft survival in Europe and the United States: strikingly different long-term outcomes

Transplantation. 2013 Jan 27;95(2):267-74. doi: 10.1097/TP.0b013e3182708ea8.


Background: Kidney graft survival has never been systematically compared between Europe and the United States.

Methods: Applying period analysis to first deceased-donor (DD) and living-donor kidney grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year graft survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics.

Results: For the 2005 to 2008 period, 1-year survival for DD grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year graft survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor grafts were similar as those seen for DD grafts. Adjusted hazard ratios for graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower graft survival is not explained by differences in baseline patient characteristics.

Conclusions: Long-term kidney graft survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term graft survival differences between Europe and the United States is a high priority for improving long-term graft survival.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Age Distribution
  • Age Factors
  • Aged
  • Child
  • Child, Preschool
  • Europe
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control
  • Graft Survival*
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infant
  • Infant, Newborn
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / ethnology
  • Kidney Transplantation / immunology
  • Kidney Transplantation / mortality
  • Kidney Transplantation / statistics & numerical data*
  • Living Donors
  • Middle Aged
  • Proportional Hazards Models
  • Racial Groups / statistics & numerical data*
  • Registries
  • Risk Assessment
  • Risk Factors
  • Survival Analysis
  • Time Factors
  • Tissue and Organ Procurement / statistics & numerical data
  • Treatment Outcome
  • United States
  • Whites / statistics & numerical data
  • Young Adult


  • Immunosuppressive Agents