Life expectancy after kidney transplantation in a population-based retrospective cohort

Kidney transplantation is the treatment of choice for end-stage renal disease, offering significant survival benefits. However, outcomes vary based on donor type and patient characteristics. We aimed to identify factors influencing long-term survival following kidney transplantation. This was a population-based retrospective cohort study of kidney transplant recipients from 2005 to 2018 in Israel, assessing survival from one-month post-transplant. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. Among 1,847 recipients, 679 received kidneys from living donors and 1,168 from deceased donors. The median age was 52 years (IQR 38–62), and the mean post-transplant survival time was 11.9 years (95% CI 11.7–12.3). Increased mortality risk was associated with age over 65 years (HR 3.73), current or past smoking (HR= 1.32), diabetes mellitus (HR= 1.79), heart failure (HR= 1.49), and atrial fibrillation (HR= 1.79). Receiving a kidney from a living donor (HR= 0.49) and higher pre-transplant hemoglobin levels (HR= 0.75) were linked to improved survival. Recipient comorbidities and donor type are key determinants of post-transplant outcomes. These findings support a tailored approach to transplant evaluation, balancing potential survival and quality-of-life benefits with individual risk profiles.