The golden years Kidney transplant outcomes in the 21st century

The research reported in this thesis examines kidney transplant survival outcomes in the current European transplant era.
Before one can address and solve a problem, one needs to understand the magnitude of the problem. In the first part of this thesis we present the age- and sex-specific lifetime risk of renal replacement therapy (RRT) for end-stage renal disease across Europe; provide a summary of the epidemiology of RRT in 2015 in 36 countries; and give an overview of the ten-year trends in the incidence, prevalence and survival of patients receiving RRT in 18 European countries.
The second part of this thesis focuses on issues related to kidney transplantation in the 21st century; the older adult either as a potential recipient or donor is the major focus of this section. Firstly we determine the access to transplantation in adults aged 75-84 years. By means of the kidney donor risk index we assess for temporal changes in kidney quality. We then explore what the best use for these older deceased donor kidneys might be by examining the outcomes of young kidney transplant recipients receiving either young or old deceased donor kidneys. Thereafter the focus turns to the living donor; we examine the evidence pertaining to pregnancy outcomes in living kidney donors, and the consistency between guidelines discussing this issue.
The final part of this thesis examines kidney transplant survival outcomes in individuals with either primary glomerulonephritis or scleroderma.
We conclude with a general discussion of this thesis and recommendations for future research.