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Background: Socioeconomic status (SES) has been associated with early mortality in cancer patients. However, the association between SES and outcome in colorectal cancer patients is largely unknown. The aim of this study was to investigate whether SES is associated with short- and long-term outcome in patients undergoing curative surgery for colorectal cancer.Methods: Patients who underwent curative surgery in the region of Rotterdam for stage I-III colorectal cancer between January 2007 and July 2014 were included. Gross household income and survival status were obtained from a national registry provided by Statistics Netherlands Centraal Bureau voor de Statistiek. Patients were assigned percentiles according to the national income distribution. Logistic regression and Cox proportional hazard regression were performed to assess the association of SES with 30-day postoperative complications, overall survival and cancer-specific survival, adjusted for known prognosticators.Results: For 965 of the 975 eligible patients (99%), gross household income could be retrieved. Patients with a lower SES more often had diabetes, more often underwent an open surgical procedure, and had more comorbidities. In addition, patients with a lower SES were less likely to receive (neo) adjuvant treatment. Lower SES was independently associated with an increased risk of postoperative complications (Odds ratio per percent increase 0.99, 95%CI 0.99-0.998, p = 0.004) and lower cancer-specific mortality (Hazard ratio per percent increase 0.99, 95%CI 0.98-0.99, p = 0.009).Conclusion: This study shows that lower SES is associated with increased risk of postoperative complications, and poor cancer-specific survival in patients undergoing surgery for stage I-III colorectal cancer after correcting for known prognosticators. [ABSTRACT FROM AUTHOR]

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Background: The diagnosis of hepatocellular adenoma (HA) has a great impact on the lives of young women and may pose clinical dilemmas to the clinician since there are no standardized protocols to follow. We aimed to establish expert opinions on diagnosis and treatment of HA by collecting data from a nationwide questionnaire in the Netherlands. Methods: A questionnaire was sent to 20 Dutch hospitals known to offer hepatologic and surgical experience on liver tumours. Results: 17 hospitals (85%) responded to the questionnaire. Annually, a median of 52 patients presented with a solid liver tumour. In 15 (88%) hospitals, hepatic adenomas were diagnosed with contrast-enhanced, multiphase spiral CT or MRI. In 2 (12%) hospitals, histology was required as part of a management protocol. Surveillance after withdrawal of oral contraceptives was the initial policy in all clinics. MRI, CT or ultrasound was used for follow-up. Criteria for surgical resection were a tumour size >5 cm and abdominal complaints. In 5 (29%) hospitals, patients were dismissed from follow-up after surgery. In complex cases (e.g. large, multiple or centrally localized lesions, a wish for pregnancy), the treatment policy was highly variable. Pregnancy was not discouraged in 15 hospitals, but in 11 (65%) of these, strictly defined conditions were noted: frequent follow-up, peripheral tumour localization that makes surgery easier if necessary, stable tumour size, and a good informed consent. Conclusion: The management of HAs in the Netherlands is rather uniform, except in complex cases in which multiple factors may influence policy. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Although guidelines recommend adjuvant chemotherapy for stage III colon cancer patients, many patients do not receive adjuvant chemotherapy. The aim of this study was to identify reasons for guideline non-adherence and assess the effect on patient outcomes in a multicenter cohort of stage III colon cancer patients who received surgery plus adjuvant chemotherapy or surgery alone., Methods: Patients who underwent surgery between 2007 and 2017 were included. Reasons for non-adherence were determined. Propensity score analyses with inverse probability weighting were performed to adjust for confounding factors. Cox proportional hazards regression and risk stratified analyses were performed to assess the association of guideline adherence and other potential predictors with recurrence free survival (RFS)., Results: Data of 575 patients were included of whom 61% received adjuvant chemotherapy. In 87 of 222 patients (39%) who did not receive adjuvant chemotherapy, no reason was documented. Only age was predictive for receiving chemotherapy. Patients who received adjuvant chemotherapy had longer RFS (HR 0.42, 95%CI 0.29-0.62, p < 0.001). High T- and N-stage were associated with poorer RFS HR 2.0 (95%CI 1.58-2.71, p < 0.001) and HR 2.19 (95%CI 1.60-2.99, p < 0.001) respectively. Risk groups were identified with distinct prognosis and treatment effect and a nomogram is presented to visualize individualized RFS differences., Conclusion: This study shows considerable variation in guideline adherence to adjuvant chemotherapy and poor documentation on reasons for non-adherence. Optimizing adherence and gaining insight in reasons for non-adherence is advocated as this can lead to significant RFS benefit, especially in patients with high T-and N-stage tumors., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Aim: To develop a decision model for the population-level evaluation of strategies to improve the selection of stage II colon cancer (CC) patients who benefit from adjuvant chemotherapy., Methods: A Markov cohort model with a one-month cycle length and a lifelong time horizon was developed. Five health states were included; diagnosis, 90-day mortality, death other causes, recurrence and CC death. Data from the Netherlands Cancer Registry were used to parameterize the model. Transition probabilities were estimated using parametric survival models including relevant clinical and pathological covariates. Subsequently, biomarker status was implemented using external data. Treatment effect was incorporated using pooled trial data. Model development, data sources used, parameter estimation, and internal and external validation are described in detail. To illustrate the use of the model, three example strategies were evaluated in which allocation of treatment was based on (A) 100% adherence to the Dutch guidelines, (B) observed adherence to guideline recommendations and (C) a biomarker-driven strategy., Results: Overall, the model showed good internal and external validity. Age, tumor growth, tumor sidedness, evaluated lymph nodes, and biomarker status were included as covariates. For the example strategies, the model predicted 83, 87 and 77 CC deaths after 5 years in a cohort of 1000 patients for strategies A, B and C, respectively., Conclusion: This model can be used to evaluate strategies for the allocation of adjuvant chemotherapy in stage II CC patients. In future studies, the model will be used to estimate population-level long-term health gain and cost-effectiveness of biomarker-based selection strategies.

Background: It is estimated that around 15-30% of patients with early stage colon cancer benefit from adjuvant chemotherapy. We are currently not capable of upfront selection of patients who benefit from chemotherapy, which indicates the need for additional predictive markers for response to chemotherapy. It has been shown that the consensus molecular subtypes (CMSs), defined by RNA-profiling, have prognostic and/or predictive value. Due to postoperative timing of chemotherapy in current guidelines, tumor response to chemotherapy per CMS is not known, which makes the differentiation between the prognostic and predictive value impossible. Therefore, we propose to assess the tumor response per CMS in the neoadjuvant chemotherapy setting. This will provide us with clear data on the predictive value for chemotherapy response of the CMSs., Methods: In this prospective, single arm, multicenter intervention study, 262 patients with resectable microsatellite stable cT3-4NxM0 colon cancer will be treated with two courses of neoadjuvant and two courses of adjuvant capecitabine and oxaliplatin. The primary endpoint is the pathological tumor response to neoadjuvant chemotherapy per CMS. Secondary endpoints are radiological tumor response, the prognostic value of these responses for recurrence free survival and overall survival and the differences in CMS classification of the same tumor before and after neoadjuvant chemotherapy. The study is scheduled to be performed in 8-10 Dutch hospitals. The first patient was included in February 2020., Discussion: Patient selection for adjuvant chemotherapy in early stage colon cancer is far from optimal. The CMS classification is a promising new biomarker, but a solid chemotherapy response assessment per subtype is lacking. In this study we will investigate whether CMS classification can be of added value in clinical decision making by analyzing the predictive value for chemotherapy response. This study can provide the results necessary to proceed to future studies in which (neo) adjuvant chemotherapy may be withhold in patients with a specific CMS subtype, who show no benefit from chemotherapy and for whom possible new treatments can be investigated., Trial Registration: This study has been registered in the Netherlands Trial Register (NL8177) at 11-26-2019, https://www.trialregister.nl/trial/8177 . The study has been approved by the medical ethics committee Utrecht (MEC18/712).

The aim of this study is to review the surgical outcome of kidney retransplantation in the ipsilateral iliac fossa in comparison to first kidney transplants. The database was screened for retransplantations between 1995 and 2013. Each study patient was matched with 3 patients with a first kidney transplantation. Just for graft and patient survival analyses, we added an extra control group including all patients receiving a second transplantation in the contralateral iliac fossa. We identified 99 patients who received a retransplantation in the ipsilateral iliac fossa. There was significantly more blood loss and longer operative time in the retransplantation group. The rate of vascular complications and graft nephrectomies within 1 year was significantly higher in the study group. The graft survival rates at 1 year and 3, 5, and 10 years were 76%, 67%, 61%, and 47% in the study group versus 94%, 88%, 77%, and 67% (p < 0.001) in the first control group versus 91%, 86%, 78%, and 57% (p = 0.008) in the second control group. Patient survival did not differ significantly between the groups. Kidney retransplantation in ipsilateral iliac fossa is surgically challenging and associated with more vascular complications and graft loss within the first year after transplantation. Whenever feasible, the second renal transplant (first retransplant) should be performed contralateral to the prior failed one., (© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.)

The impact of living kidney donation on donors' mental health has not been sufficiently nor comprehensively studied. Earlier studies demonstrated that mental health did not change in the majority of donors, however they often lacked a suitable control group and/or had other methodological limitations. Consequently, it remains unclear whether changes in mental health found among a minority of donors reflect normal fluctuations. In this study we matched 135 donors with individuals from the general Dutch population on gender and baseline mental health and compared changes in mental health over time. Mental health was measured using the Brief Symptom Inventory and Mental Health Continuum Short Form. Primary analyses compared baseline and 6 months follow-up. Secondary analyses compared baseline and 9 (controls) or 15 months (donors) follow-up. Primary multilevel regression analyses showed that there was no change in psychological complaints (p = 0.20) and wellbeing (p = 0.10) over time and donors and controls did not differ from one another in changes in psychological complaints (p = 0.48) and wellbeing (p = 0.85). Secondary analyses also revealed no difference in changes between the groups. We concluded that changes in mental health in the short term after donation do not significantly differ from normal fluctuations found in the Dutch general population., (© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Aim: The incidence, patterns of care and survival were determined in patients with stage IV colorectal cancer (CRC) in a population-based series., Method: Computer records for patients diagnosed with stage IV CRC diagnosed from 1 January 1995 to 31 December 2007 were retrieved from the Rotterdam Cancer Registry. Surgical resection of the primary tumour, chemotherapy use, hepatic surgery and survival were evaluated according to year of diagnosis, age, gender and primary tumour site., Results: In the southwestern part of the Netherlands, 19 014 new patients with CRC were diagnosed and synchronous metastatic disease was found in 3482 (18%). This proportion increased during the study period, from 16% to 21%. Surgical resection of the primary tumour was performed in approximately 50% of the patients and did not change over time. Postoperative 30-day mortality was 8%. Chemotherapy use increased from 18% in the first period to 56% in the latest period. Liver surgery increased from 4% in the first period to 10% in the latest period. Median survival increased from 7 months to 12 months and 2-year survival increased from 14% to 28%. Two-year survival declined with increasing age and was significantly worse for right-sided tumours (14%)., Conclusion: Survival of patients with stage IV CRC has improved over time and this is probably a result of the increased use of chemotherapy and the increased numbers of patients who underwent hepatic surgery., (© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.)

Due to lengthening waiting lists for kidney transplantation, a debate has emerged as to whether financial incentives should be used to stimulate living kidney donation. In recent surveys among the general public approximately 25% was in favor of financial incentives while the majority was opposed or undecided. In the present study, we investigated the opinion of living kidney donors regarding financial incentives for living kidney donation. We asked 250 living kidney donors whether they, in retrospect, would have wanted a financial reward for their donation. We also investigated whether they were in favor of using financial incentives in a government-controlled system to stimulate living anonymous donation. Additionally, the type of incentive deemed most appropriate was also investigated. In general almost half (46%) of the study population were positive toward introducing financial incentives for living donors. The majority (78%) was not in favor of any kind of reward for themselves as they had donated out of love for the recipient or out of altruistic principles. Remarkably, 60% of the donors were in favor of a financial incentive for individuals donating anonymously. A reduced premium or free health insurance was the preferred incentive., (©2010 The Authors Journal compilation©2010 The American Society of Transplantation and the American Society of Transplant Surgeons.)

In Europe, living kidney donation rates differ considerably from country to country. These differences are related to deceased kidney donation rates: countries with higher deceased donation rates have lower living donation rates. Despite the differences, all countries have one thing in common, namely, the shortage of kidneys for transplantation. Living kidney donation is a good option to alleviate these shortages. In our center, 60% to 70% of all kidney transplants come from living donors. This article describes various strategies that may have contributed to these high living donation rates: team attitude, educational materials and meetings, and alternative donation programs (exchange donation, domino-paired donation, Good Samaritan donation). Also described are some less conventional strategies for increasing rate of living kidney donation that are not used in the Netherlands but may offer some good perspectives (e.g., the "Norwegian approach" and home-based educational programs).

Objective: To establish the current expert opinions on the diagnosis and treatment of hepatocellular adenoma in the Netherlands., Design: Questionnaire., Method: In 2005, a questionnaire concerning the incidence, diagnosis, treatment, management in case of pregnancy, and follow-up of hepatocellular adenoma was sent to 20 Dutch hospitals with a tertiary referral role. In addition, they were asked to describe the indicated treatment in 5 imaginary cases., Results: 17 hospitals (85%) responded. A median of 52 patients per hospital presented with a solid liver tumour annually. Between 1 and 40% of these patients had benign lesions with a differential diagnosis of adenoma, focal nodular hyperplasia, and haemangioma. In 15 clinics (88%), hepatic adenomas were diagnosed with contrast-enhanced, multiphasic, spiral CT or MRI series. 2 clinics (12%) required a histological diagnosis. Conservative management (withdrawal of oral contraceptives and radiological control) was initially given in all clinics. MRI, CT or ultrasound were used to follow adenoma patients with different time schedules. The criteria for surgical resection were a tumour size > 5 cm and abdominal complaints. In 5 clinics (29%), the patients were no longer followed after surgery. In cases in which multiple factors played a role (size, location, number of lesions, and wish to become pregnant), the treatment policy was highly variable. Pregnancy was not discouraged in 15 clinics, but in 11 (65%) only under strict conditions: frequent control, a peripheral location that makes surgery possible if necessary, a stable tumour size, and an understanding of the risks., Conclusion: The management of hepatocellular adenomas in the Netherlands is rather uniform, except for differences in the methods of observation and the treatment policy in cases in which multiple factors play a role.

The aims of this study were to assess the technical effectiveness of radiofrequency (RF) ablation in patients with primary or secondary hepatic malignancies and to determine survival and complication rates. This was a retrospective analysis of prospectively collected data of patients treated with RF ablation and controlled for recurrence every 3 months by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The outcome is compared with a comprehensive review of data published in recent literature. Forty-seven patients underwent 50 RF sessions for the ablation of 73 tumors. Local tumor progression was observed in 11 patients (23%). A tumor sized larger than 30 mm, a tumor load larger than 14 cm3, and a percutaneous approach were associated with a faster time to local tumor progression. At the end of a mean (+/- SD) follow-up period of 11.4 +/- 7.5 months, 39 patients (83%) were alive, including eight patients with recurrent disease. The overall cumulative survival rates at 12 and 24 months were 87% and 70%, respectively. In our center, RF ablation can be safely performed to achieve adequate local control and survival rates. Time to local tumor progression was significantly related to initial size of the tumor and tumor load.

We studied the willingness and motives for accepting a living kidney donation in 61 kidney patients on the waiting list by a semistructured interview and a questionnaire on two occasions. Between both moments of measurement patients received general information on transplantation options. We tested whether demographic data, medical status data or quality of life correlated with treatment choice. Our results showed that 61% of the patients preferred living kidney donation to postmortal donation. Their main motivation for this choice was the better quality of the living kidney. The most often named reasons to choose postmortal donation were unwillingness to burden a loved one and fear of psychological problems in relation to the donor after transplantation. There was no statistical significant change of preference between both moments of measurement; however there seemed to be a tendency in favor of living kidney donation. Fewer years spent on renal replacement therapy correlated statistically significant with the choice for living kidney donation. These findings encourage the development of new strategies to facilitate the living kidney donation program, and confirm the need for the standard option of psychosocial support for patients.

Introduction: The increasing number of immigrant residents has resulted in more foreign patients on the kidney transplant waiting list. While the willingness of their relatives to participate in a living kidney donation program is not different from that of relatives of autochthonous patients, many extra logistic and financial problems have to be solved, when the potential donor has to travel to Rotterdam. The fear of the authorities that the donor might stay in the Netherlands after donation is another hurdle., Methods and Results: We analysed 395 living kidney transplantations performed in Rotterdam from 1981 to 2003. In 32 instances the donor came from abroad. Another 14 potential foreign donors came to Rotterdam but did not donate for various reasons. We calculated the costs for visa, travel, insurance, and loss of income. Total financial impact for the 46 (potential) donors, amounted to capital JE, Ukrainian 56,604.09, which is capital JE, Ukrainian 1768.88 per actual performed donation. One kidney donor remained illegally in the Netherlands., Conclusion: We conclude that the efforts and support for foreign kidney donors to come to the Netherlands is justified and cost-effective. No evidence was found for a kidney donation immigration route.

To examine recent trends of hepatocellular carcinoma (HCC) in an unselected patient population in the Western world, cancer registration data of HCC in the Netherlands were analysed. Trends in incidence, mortality, treatment and survival, according to gender, age, stage of disease and period of diagnosis were studied. Age-standardised incidence of HCC in the Netherlands did not rise from 1989 to 2000. In men older than 75 years, there was a significant increase. Mortality due to primary liver cancer increased from 1989 to 2000. There was no change in the treatment pattern (1989-1998), whereas 73% of patients with HCC received no cancer-related therapy during this period of analysis. Twelve percent of the patients underwent either a partial liver resection or orthotopic liver transplantation. This low percentage suggests that patients with HCC must be analysed and discussed in specialised centres to minimise the number of patients not receiving possible curative therapy.

In the Netherlands, cross-over kidney transplantation has been introduced as an extra option in the living kidney donation programme. In cross-over transplantation, patients who cannot be given their own partner's kidney for immunological reasons are given a kidney from the partner of another patient in exchange for a kidney from their own partner. There is no difference in the medical indications and contraindications between direct and indirect living donation. There are no ethical obstacles since the net gain for the two couples is no different from that of direct living kidney donation and because the exchange takes place on the basis of equality. One should be aware that the extra possibilities may result in more psychological pressure on potential donors. It is important that the donation procedures start at the same moment and that the wishes of patients and donors for anonymity be preserved. A successful cross-over kidney transplantation programme requires a large pool of donors and patients. Therefore, this has been organised in a national programme. The Dutch Transplantation Foundation is responsible for the allocation of cross-over kidneys. Organ trade will thus be impossible. The seven Dutch centres for kidney transplantation have developed a protocol.

In the period 1996-2001, the number of transplanted postmortal kidneys decreased from 425 to 380, while at the same time the number of kidneys transplanted from living donors increased from 81 in 1996 to 155 per year in 2001. There was a striking increase in the proportion of living non-related donors (59/155). Although the short-term results of kidney transplantation have improved, and kidneys are very rarely lost as a consequence of acute rejection, the average life of a transplanted kidney has scarcely improved. Chronic allograft dysfunction is now the major cause of transplant loss. This process is hardly influenced by the immunosuppressive drugs currently used. To improve the cardiovascular risk profile, several centres discontinue the use of cyclosporin, tacrolimus or prednisone at 6 or 12 months after transplantation or substitute these with other drugs. This is complicated by acute rejection episodes in 10-20% of patients. With the arrival of a number of new immunosuppressive drugs the risk of rejection might be reduced.

There is still no consensus on the treatment of elevated serum cholesterol in patients with a renal transplant. In the general population treatment is age dependent. We studied the influence of serum cholesterol 1 year after transplantation in all 676 recipients of a kidney graft transplanted in Rotterdam that survived and functioned for at least 1 year. The other variables included in this analysis are: donor and recipient age and gender, original disease, race, number of HLA A and B mismatches, number of previous transplantations, postmortal or living related transplantation and transplantation year. At 1 year after transplantation the following variables were included: serum cholesterol, serum creatinine, proteinuria and hypertension. In the Cox proportional hazards analysis, serum cholesterol at 1 year after transplantation turned out to be an important, independent variable influencing patient failure. The influence was linear but there was interaction with recipient age. The negative influence of serum cholesterol on the RR for patient failure decreased with increasing recipient age. For example, the proportional increase in RR of a 20-year-old with a serum cholesterol of 12 mmol/l compared with that of a cholesterol of a patient with serum cholesterol of 6 mmol/l was 6. In a 60-year-old with a cholesterol of 12 mmol/l the proportional increase in RR was only 1.2 compared with a contemporary with a cholesterol of 6 mmol/l. Serum cholesterol levels have an independent influence on patient failure. The RR is influenced by recipient age, so that the negative effect of increasing cholesterol levels in the elderly is overruled by the RR of age and disappears.

Background/aims: The results of hepatic surgery for colorectal metastases are distorted by the high incidence of recurrence, despite an apparently radical resection. Selection of high-risk patients is a mandatory step towards effective application of neo-adjuvant chemotherapy. In this study, expression of the tumor suppresser gene p53 in colorectal liver metastases was correlated with recurrence after resection., Methodology: In a retrospective case-series p53 expression was assessed using standard immunohistochemical methods in the paraffin-embedded specimens of 45 liver resections for colorectal metastases, performed in 43 patients in a single institution between '86 and '96. Hospital and office charts were reviewed and follow-up was completed with a General Physicians' questionnaire in October '97. Relapse-free and cancer-specific survival from diagnosis of hepatic metastases were assessed and compared for p53+ and p53- groups., Results: Median survival was 36 months with an estimated 5-year cancer-specific survival of 43% (95% confidence interval 35%-51%). Relapse-free and cancer-specific survival were not significantly different between p53+ (n = 24, 53%) and p53- (n = 21) groups (P = 0.86 and P = 0.91 respectively). P53 expression was not associated with other potential predictors, which were not of predictive value either., Conclusions: Patients at risk for recurrent disease following partial hepatectomy for colorectal metastases cannot be identified by p53 expression.

Currently xenotransplantation is being discussed on national and international levels as a possible solution to tranplantation waiting lists, in view of the lack of alternative therapies. In recent years, enormous progress has been made in the area of immunology, especially concerning hyperacute rejection. However, long-term survival is still fiction due to relatively unknown, sequential rejection processes. Moreover, it remains questionable if xenogeneic organs will function physiologically, especially if they are metabolically complex. A third problem is the possible infectious risk of xenotransplantation to the patient and the population. Regarding this hazard, various committees and policy reports demand clarity first before the initial clinical transplantations become fact. In the Netherlands, the government largely adopted an identical advice by the Health Council. Artificial organs and cloning developments indicate that xenotransplantation might merely be an intermediate station in the route to develop adequate treatment for patients with organ failure.

Objective: Evaluation of safety and technical feasibility of laparoscopic live donor nephrectomy., Design: Descriptive., Method: The per- and postoperative results were analysed of 15 patients subjected to laparoscopic live donor nephrectomy in the Erasmus Medical Centre Rotterdam, Dept. of General Surgery, the Netherlands. Both left and right nephrectomy were performed via the transperitoneal route. The kidney was removed via a subumbilical incision., Results: Laparoscopic donor nephrectomy was attempted in 15 patients and completed successfully in 14. Conversion to flank incision was resorted to one patient because of a venous bleeding. Median operating time was 290 min (SD: 57). Mean warm ischaemia time was 7 min (range: 4-17), including laparoscopic harvest. All kidneys were functioning well after transplantation. The mean duration of postoperative hospitalization of the donors was 4 days., Conclusion: Laparoscopic live donor nephrectomy is a safe and technically feasible procedure in a kidney transplant programme involving a living relative.

Most studies on the influence of recipient race on kidney transplant survival have been performed in the United States. Generally, they show a lower survival in African-Americans than in Caucasians. Since Rotterdam has gradually become a multi-ethnic society, we were able to study the effect of origin on kidney survival. We restricted our study to recipients of a primary cadaveric kidney graft between July 1983 and July 1997 who received cyclosporin as primary immunosuppression. Patients were divided into two main groups according to origin: European (n = 399) and non-European (n = 110). No statistical differences were found for mean donor age, sex distribution, or the total number of HLA-A and DR mismatches. Non-Europeans had significantly more mismatches on their HLA-B locus (P = 0.01) and recipient age was lower (P = 0.003). The reason non-Europeans had lost their native kidneys was more often hypertension and less often congenital or hereditary diseases compared to Europeans. The causes of death and of transplant failure did not differ. A multivariate Cox proportional hazards analysis did not show European or non-European origin to be an independent predictor of graft survival (two categories, P = 0.25). The variable origin in five categories did show an independent influence on graft survival, with Arab en African recipients running higher risks than European and Asian recipients. We conclude that, in our center, the prognosis after kidney transplantation is comparable for Europeans and non-Europeans; however, in the subcategories, Arab and African recipients have a worse prognosis.