Survival of Renal Transplant Patients: Data From a Tertiary Care Center in Turkey

Kidney transplantation in Romania: two transplant centers experience

PURPOSE

Kidney graft survival rates improved from decade to decade, but data about factors that affect patient and graft survival remain challenging and even controversial.

METHODS

We analyzed retrospectively data from kidney transplanted patients followed in two Romanian transplant centers (Iasi and Bucharest)-new programmes specifically developed after 1989 to cover transplantation requirements for two-thirds of Romania. We used a composite survival outcome defined as 50% reduction in estimated glomerular filtration rate (eGFR), return to dialysis or death. Survival analysis was performed using uni- and multivariable Cox regression with baseline and time-updated covariates.

RESULTS

From the entire cohort of 365 patients, 243 had the outcome of interest. In the univariable Cox survival analysis, age, hemoglobin, eGFR, cholesterol, AST and transplant center were associated with the outcome. The multivariable Cox analysis reveals that only cholesterol (HR 0.97, 95% CI 0.94-0.99 per 10 mg/dL increase) and transplant center (HR 3.64, 95% CI 2.67-4.97) remain associated. For the time-updated Cox survival analysis we found that eGFR (HR 0.91, 95% CI 0.87-0.96 per 10 ml/min/1.73 m² increase) and cholesterol are associated with the outcome in the univariable analysis and only eGFR and transplant center in the multivariable Cox survival analysis.

CONCLUSIONS

Our study reports data from two distinct transplant centers from a developing country. Our results are similar to the current literature data, but also reveal that the approach of a center to the transplantation management is an independent factor associated with graft survival.

Risk Factors Affecting Graft and Patient Survivals After Transplantation From Deceased Donors in a Developing Country: A Single-Center Experience

AIM

The aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors.

METHODS

We retrospectively analyzed the outcomes of 186 transplantations from deceased donors performed at our center between 2006 and 2014. The recipients were divided into two groups: Group I (141 recipients without graft loss) and Group II (45 recipients with graft loss). Kaplan-Meier, log-rank test, and Cox proportional hazard regressions were used.

RESULTS

The characteristics of both groups were similar except renal resistive index at the last follow-ups. When graft survival and mortality at the first, third, and fifth years were analyzed, tacrolimus (Tac)-based regimens were superior to cyclosporine (CsA)-based regimens (P < .001). Risk factors associated with graft survival at the first year included cardiac cause of death (versus cerebrovascular accident [CVA]; hazard ratio [HR], 6.36; 95% confidence interval [CI], 1.84-22.05; P = .004), older transplant age (HR, 1.05; 95% CI, 1.02-1.08; P < .001), and high serum creatinine level at 6 months post-transplantation (HR, 1.74; 95% CI, 1.48-2.03; P < .001), whereas younger donor age decreased risk (HR, 0.97; 95% CI, 0.95-1.00; P = .019). Also, the Tac-based regimen had a 3.63-fold (95% CI, 1.47-8.97; P = .005) lower risk factor than the CsA-based regimen, and 2.93-fold (95% CI, 1.13-7.63; P = .027) than other regimens without calcineurin inhibitors. When graft survival at 3 years was analyzed, diabetes mellitus was lower than idiopathic causes and pyelonephritis (P = .035). In Cox regression analysis at year 3, older transplantation age (HR, 1.20; 95% CI, 1.04-1.39; P = .014) and serum creatinine level at month 6 post-transplantation (HR, 1.65; 95% CI, 1.42-1.90; P < .001) were significant risk factors for graft survival. Hemodialysis (HD) plus peritoneal dialysis (PD) treatment was 2.22-fold (95% CI, 1.08-4.58; P = .03) risk factor than only HD before transplantation. When graft survival and mortality at year 5 were analyzed, diabetes mellitus was lower compared with all other diseases. In Cox regression analysis at year 5, younger donor age (HR, 0.73; 95% CI, 0.62-0.86; P < .001) was protective for graft survival, whereas older transplantation age (HR, 1.40; 95% CI, 1.20-1.64; P < .001) and serum creatinine level at month 6 of post-transplantation (HR, 1.39; 95% CI, 1.19-1.61; P < .001) were significant risk factors. PD increased 3.32 (95% CI, 1.28-8.61; P = .014) times the risk than HD. In Cox regression analysis at year 1, cardiac cause of death (versus CVA; HR, 5.28; 95% CI, 1.37-20.31; P = .016), CsA-based regimen (versus Tac; HR, 4.95; 95% CI, 1.78-13.78; P = .002), HD plus PD treatment (versus alone HD; HR, 3.26; 95% CI, 1.28-8.30; P = .013), older transplantation age (HR, 1.08; 95% CI, 1.04-1.11; P < .001), serum creatinine level at month 6 post-transplantation (HR, 1.34; 95% CI, 1.11-1.62; P = .003), and low HLA mismatches (HR, 1.67; 95% CI 1.01-2.70; P = .044) were risk factors for mortality. At year 3, CsA-based regimen (versus Tac; HR, 3.54; 95% CI, 1.32-9.47; P = .012), PD (versus HD; HR, 5.04; 95% CI, 1.41-18.05; P = .013), HD plus PD treatment (versus alone HD; HR, 3.51; 95% CI, 1.37-9.04; P = .009), and older transplantation age (HR, 1.27; 95% CI 1.05-1.53; P = .015) were risk factors for mortality. At year 5, older age at transplantation (HR, 1.47; 95% CI, 1.23-1.77; P < .001), PD (versus HD; HR, 9.21; 95% CI, 3.09-27.45; P < .001), and CsA-based regimen (versus Tac; HR, 2.75; 95% CI, 1.04-7.23; P = .041) were risk factors for mortality, whereas younger donor age decreased risk (HR, 0.71; 95% CI, 0.56-0.86; P < .001).

CONCLUSION

Death of donor with cardiac cause, CsA-based immunosuppressive regimen, donor age, serum creatinine level at month 6 post-transplantation, and renal replacement therapy before transplantation affected mortality and graft survival in deceased donors.