What is the transplant success rate for a patient with end-stage organ failure undergoing a transplant, considering factors such as age, comorbidities, and donor organ quality?

Transplant Success Rates

Transplant success rates vary significantly by organ type, with heart transplantation achieving approximately 85% one-year survival and 75-80% five-year survival, while kidney transplantation demonstrates 87% graft survival at 15 years for combined liver-kidney transplants in appropriate candidates. 1

Organ-Specific Success Rates

Heart Transplantation

• One-year survival approaches 85% with in-hospital mortality under 5% 1
• Five-year survival rates reach 75-80% in contemporary practice 1
• These outcomes represent dramatic improvement over the 30-40% annual mortality rate of untreated end-stage heart failure 1

Kidney Transplantation

• Combined liver-kidney transplantation (CLKT) achieves 87% kidney graft survival at 15 years compared to only 14% with isolated kidney transplantation in patients with primary hyperoxaluria (adjusted HR for graft failure 0.14,95% CI 0.05-0.41) 1
• Five-year kidney graft survival ranges from 48-89% for CLKT versus 14-45% for isolated kidney transplantation in high-risk populations 1
• Patient survival remains similar between approaches despite differences in graft survival 1

Liver Transplantation

• One-year survival of 85% can be achieved with appropriate donor selection 2
• Primary graft nonfunction occurs in approximately 2.2% of cases with optimal donor selection 2
• Primary graft dysfunction rates of 8.2% are reported, with higher rates in suboptimal grafts 2

Critical Factors Affecting Success

Donor Quality

• Donor age significantly impacts outcomes, particularly in donation after circulatory death (DCD) liver transplantation where donors aged 50-60 years show 39% increased risk of graft failure, and those over 60 years show 88% increased risk 1
• Cold ischemia time increases graft failure risk by 6% per hour in DCD liver transplantation 1
• Donor body mass index ≥25 kg/m² combined with age >60 years significantly compromises graft survival 1

Recipient Selection

• Age, comorbidities, and end-organ damage from conditions like diabetes serve as exclusion criteria that directly impact success rates 1
• Pulmonary hypertension with irreversibly high pulmonary vascular resistance (>6 Wood units or >3.0 Wood units after vasodilator treatment) represents a contraindication to heart transplantation 1
• Renal dysfunction with creatinine >2 mg/dL or creatinine clearance <60 mL/min serves as a secondary exclusion criterion 1

Early Complications and Quality Metrics

Short-Term Outcomes

• Acute kidney rejection occurs in only 4.2% of combined liver-kidney transplant recipients compared to 32.6% in isolated kidney transplant patients 3
• Acute liver rejection develops in 31.1% of combined transplant cases 3
• Severe polymicrobial infection represents the leading cause of early mortality in combined organ transplantation 3

Performance Monitoring

• Thirty-day complication rates including infections (pneumonia, UTI, bacteremia, surgical site infection), cardiovascular events (MI, cardiac arrest, DVT, PE, stroke), blood transfusions, and unplanned operations serve as key quality indicators 1
• Unplanned readmission within 30 days of discharge represents another critical metric for transplant center performance 1

Common Pitfalls to Avoid

Avoid combining multiple donor risk factors such as advanced age, high BMI, prolonged ischemia time, and high recipient MELD scores, as these compound to dramatically worsen outcomes 1

Do not assume younger DCD donors guarantee success when other unfavorable factors exist 1

Recognize that pyridoxine-sensitive patients with primary hyperoxaluria may be candidates for isolated kidney transplantation rather than combined liver-kidney transplantation, as event-free survival is comparable in this specific population 1

Monitor for the 8.8% risk of chronic renal allograft rejection and 42.2% rate of chronic hepatic dysfunction in combined transplant recipients during long-term follow-up 3