ORIGINAL RESEARCH article
Front. Med.
Sec. Nephrology
This article is part of the Research TopicAlloimmunity in Kidney Transplantation: From Mechanisms to Clinical TranslationView all 3 articles
Factors Associated with 25-Year Kidney Transplant Survival: A Single-Center Retrospective Analysis
Provisionally accepted
- Medical University of Warsaw, Warsaw, Poland
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Abstract One-year outcomes after kidney transplantation (KTx) have improved markedly, yet ultra-long graft survival remains rare. We analyzed an outcome-defined sample from a single-center, single-era cohort to identify early, potentially modifiable factors associated with ≥25-year graft survival and to translate these associations into pragmatic, hypothesis-generating, center-level process targets. We retrospectively reviewed adult first solitary KTx performed in 1980–1995. Two outcome-defined, unmatched groups were compared: ultra-long survivors (ULS, graft survival ≥25 years; n=59) and early graft failure (EGF, ≤10 years; n=61). We abstracted pre-/peri-transplant variables, first-year rejection burden (0/1/≥2 treatment cycles), and longitudinal laboratory data. Unconditional logistic regression estimated adjusted associations (odds ratios, ORs) in a complete-case subset with prespecified, parsimonious adjustment (recipient and donor age). Cold ischemia time (CIT) was shorter in ULS than in EGF (1281.8±473.9 vs 1764.8±564.9 minutes; p=0.016; mean difference 483 minutes) and was associated with higher odds of EGF (per 60 minutes, adjusted OR 1.29; 95% confidence interval (CI) 1.02–1.63; p=0.032). ULS had a lower first-year rejection-treatment burden (≥1 anti-rejection treatment cycle 40.7% vs 63.9%; p=0.017). Early kidney function profiles favored ULS (lower creatinine at 6 months, 1 year and 5 years; all p≤0.004; higher hemoglobin at 5 years; p<0.001). Exploratory time-to-event analyses showed concordant directions for CIT and rejection-treatment burden. In an exploratory univariable landmark analysis, 6-month creatinine showed moderate within-sample discrimination for EGF versus ULS (apparent area under the curve (AUC) 0.739). Overall, CIT showed the most consistent, potentially actionable association with long-term outcome in this historical cohort; however, inferences are observational and residual confounding cannot be excluded.
Keywords: Acute rejec4on, Cold ischemia 4me, Crea4nine, Early gra9 failure, Hypertension, Kidney transplanta4on, Ultra-long gra9 survival
Received: 13 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Anyszek, Czyżewski, Durlik and Wyzgał. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Łukasz Czyżewski
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