Thirty-two years of renal transplantation in Zurich.
This overview of the last 3 decades of renal transplantation at our center depicts the development from the early phase of clinical transplantation to the development of a standardized multiorgan transplant program. Between 1964 and 1996, a total of 1,703 kidney transplants were performed at the University of Zurich Hospital in Switzerland. Due to a relatively active program in the early years of renal transplantation our data provide some useful information on the long-term results of renal transplantation. We observed a steady improvement in outcomes following transplantation during the first 2 decades of our program paralleled by an improvement in graft half-life. In the last decade, however, the demographic characteristics of our recipient population have changed gradually, leading to an increased proportion of diabetics and elderly patients. Thus, during the past decade, transplant outcomes, in terms of early graft and patient survival, have stagnated. The increased proportion of diabetics being accepted for transplantation has helped to establish simultaneous kidney and pancreas transplantation as a routine procedure, thereby offering these patients the prospect of long-term rehabilitation. In order to increase the number of available kidneys for transplantation we have adopted 2 strategies. First, we have successfully used donor kidneys from non-heart-beating donors. Results achieved with this method can be equivalent to transplantation of organs from heart-beating donors when certain criteria are respected. Second, we are increasingly performing kidney transplants from living-related donors and hope to further expand our activities in this direction in the future.