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; graft failure. Conclusion: Over 19 years, this program achieved survival outcomes comparable to international standards, with progressive improvement and sexequitable results. Late mortality, rather than graft failure, has emerged as the main long-term challenge.