Experience and outcomes of kidney transplantation in a Colombian referral center

Background Kidney transplantation remains the most effective therapy for End-Stage Renal Disease. While global outcomes have improved, data from Latin America are limited. Objective to describe the institutional experience of a national kidney transplant program in Colombia and to analyze patient and graft survival, acute rejection, and graft loss over time. Methods The objective of this research was to describe the institutional experience of a national kidney transplant program in Colombia and to analyze patient, graft, and rejection-free survival across nearly two decades. A retrospective cohort study included all adults who underwent kidney transplantation at a national referral center in Colombia between April 2006 and 5 October 2025. Outcomes were overall, graft, and rejection-free survival, analyzed with Kaplan–Meier and competing-risk models, and compared across three transplant eras (2006–2011, 2012–2018, 2019–2025). Results A total of 422 kidney transplant recipients were included (38.4% female, 61.6% male). Renal vascular disease was the leading cause of kidney failure (38.5%). Kaplan–Meier analyses showed no sex differences; 1-year patient survival was 92.1% (95% CI: 87.8–94.9) in males and 96.7% (95% CI: 92.3–98.6) in females (p = 0.082). Era-stratified analyses demonstrated significant improvement in 1-year graft survival (log-rank p = 0.015) and a trend toward higher rejection-free survival, reaching 93.8% (95% CI: 88.4–96.7) in 2019–2025 (p = 0.062). In competing-risk analysis, death was more frequent than graft failure; at 15 years, cumulative incidence was 42.2% for death versus 17.8% for graft failure. Conclusion Over 19 years, this program achieved survival outcomes comparable to international standards, with progressive improvement and sex-equitable results. Late mortality, rather than graft failure, has emerged as the main long-term challenge.