Twenty-five year evolution of kidney transplantation at the Ohio State University.

Over the course of the last 25 years, we have seen dramatic improvements in the outcomes following kidney transplantation at The Ohio State University. With the employment of each new pharmacologic or biologic agent, came a reduction in the incidence of acute rejection within the first post-transplant year and beyond as reported in these analyses. This dramatic reduction in acute rejection over progressive eras translated into significantly improved graft survivals. The improved acute rejection prophylaxis provided by progressively more efficacious immunosuppression over time did not come at the expense of increased patient mortality. This improvement was observed in African-American and re-transplant patients, both generally considered to be at high risk of acute rejection and graft loss. Improvements in the outcomes for our pre-transplant sensitized patients have not been realized over the last 10 years. Additionally, African-American recipients who developed new HLA alloantibody reactivities post-transplant fared far worse than their counterparts. Future immunosuppressive regimens that are more efficacious in controlling humoral alloimmune reactivity after transplant are needed if we are to continue improving our outcomes.