Evaluation of the 1000 renal transplants carried out at the University Hospital of the Botucatu Medical School (HCFMB) - UNESP and their evolution over the years

Abstract

Introduction: The progress in kidney transplantation has been evident over the years, as well as its benefits for patients. Objectives: To evaluate the 1.000 kidney transplants performed at the Botucatu Medical School University Hospital, subdividing the patients in different periods, according to the current immunosuppression, and evaluating the differences in graft and patient survival. Methods: Retrospective cohort analysis of the transplants performed between 06/17/87 to 07/31/16, totaling 1,046 transplants, subdivided into four different periods: 1) 1987 to 2000: cyclosporine with azathioprine; 2) 2001 to 2006: cyclosporine with mycophenolate; 3) 2007 to 2014: tacrolimus with antimetabolic; and 4) 2015 to 2016: tacrolimus with antimetabolic, with increased use of the combination of tacrolimus and mTOR inhibitors. Results: There was an increase in the mean age of recipients and increase in deceased donors and their age in the last two periods. There was a reduction in graft function delay, being 54.3% in the fourth period, compared to 78.8% in the first, p = 0.002. We found a reduction in acute rejection, being 6.1% in the last period compared to 36.3% in the first, p = 0.001. Urological complications and diabetes after transplantation were more frequent in the first two periods. The rates of cytomegalovirus infection were higher in the last two periods. There was an improvement in graft survival, p = 0.003. There was no difference in patient survival, p = 0.77 (Figure 2). Conclusion: There was a significant increase in the number of transplants, with evolution in graft survival, despite the worsening in the profiles of recipients and donors.

Human pegivirus‐1 infection in kidney transplant recipients: A single‐center experience

“…Chronic kidney disease (CKD) is a global public health issue that affects approximately 120,000 people in Brazil 1 . Kidney transplantation is the treatment of choice for the majority of patients with CKD conferring better survival and long‐term quality of life when compared to patients undergoing dialysis 2 . Several factors have contributed for better prognosis for patients undergoing kidney transplantation, as improvement in surgical techniques and immunosuppressive therapy.…”

Quality of life and spirituality of patients with chronic kidney disease: pre- and post-transplant analysis

“…Study reported that QOL of patients with CKD presented similar data regarding female prevalence (20) . However, other research has shown that most renal graft recipients were male, predominantly white (21) . Regarding education, although the group had a low level, they studied on average from 2 to 5 years more, when compared to 1,621 patients in a Brazilian study conducted in 81 dialysis centers (22) .…”

Feelings, experiences and expectations of kidney transplant individuals and challenges for the nurse

“…Surveys prove that transplantation offers survival advantage and better quality of life, being also more cost-effective than dialysis (4)(5)7) . Consequently, the positive experiences taking place thanks to transplants collaborate with the feeling of well-being emphasized by transplants, greater capacity to confrontation and recognition of improved self-image.…”

“…Considered a public health problem, CKD is characterized by an insidious, irreversible, and progressive pathological process of renal function loss. Patients progressing to terminal CKD need to make use of renal replacement therapies (RRT) such as hemodialysis, peritoneal dialysis, or kidney transplant, considered the fifth stage of the CKD process (1)(2)(3)(4) . Among the treatment modalities for CKD, the kidney transplant is the best therapeutic modality and, in certain cases, it may represent the only way for the individual to survive (4)(5) .…”

“…Patients progressing to terminal CKD need to make use of renal replacement therapies (RRT) such as hemodialysis, peritoneal dialysis, or kidney transplant, considered the fifth stage of the CKD process (1)(2)(3)(4) . Among the treatment modalities for CKD, the kidney transplant is the best therapeutic modality and, in certain cases, it may represent the only way for the individual to survive (4)(5) . This procedure causes an important stress load, several psychological, existential, affective, relational and social changes, both for the individual and for those who participate in his or her life context (3) .…”