Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Abstract

OBJECTIVE:Renal transplantation is the treatment of choice in end-stage renal diseases. Long-term allograft function has remained steady in deceased donor kidney transplantation (DDKTx) during recent decades. In this study, we evaluated DDKTx outcomes at our hospital. MATERIAL and METHODS:72 cadaveric transplant patients who were grafted between January 2002 and October 2013 at our center were analysed retrospectively. Recipients and donors' demographic properties, immunologic and nonimmunologic characteristics, allograft function and emerging complications were examined. Factors associated with graft and patient loss were investigated. RESULTS:Mean follow-up period was 60±38 months. Mean recipient age was 42±11 years, of which 51.4% was male. Dialysis vintage was 83±59 months, while mean cold ischemia time was 12±3 hours. One and five year graft and patient survival rates were 94.4%, 92.3% and 97.2%, 89.9% respectively. High serum creatinine value at discharge (p=0.003) and early surgical complications (p=0.041) were independent risk factors associated with poor graft survival. Having a recipient age ≥46 years (p=0.037) and cardiovascular disease (p=0.017) caused patient loss. Cardiovascular disease was independently associated with patient loss (HR=6.45[1.08-38.70], p=0.041). CONCLUSION:In this study, it was demonstrated that creatinine value at discharge and early surgical complications were associated with allograft loss, while cardiovascular disease was associated with patient loss in DDKTx. BULGULAR: Ortalama takip süresi 60±38 aydır. Alıcıların ortalama yaşı 42±11 yıl, %51.4'ü erkektir. Nakil öncesi ortalama diyaliz süresi 83±59 aydır. Ortalama soğuk iskemi zamanı 12±3 saattir. Bir ve beş yıllık graft sağkalımı sırasıyla %94.4, %92.3; hasta sağkalımı %97.2, %89.9'dur. Hastaneden çıkış kreatinini yüksekliği (p=0.003) ve erken cerrahi komplikasyonların gelişimi (p=0.041) graft sağkalımını olumsuz etkileyen bağımsız risk faktörleridir. Alıcı yaşı≥46 olması (p=0.037) ve kardiyovasküler hastalık gelişimi (p=0.017) hasta kaybını artırmaktadır. Kardiyovasküler hastalık gelişimi hasta kaybı için bağımsız risk faktörüdür (HR=6,], p=0.041).SONUÇ: Çalışmada, kadaverik böbrek nakillerinde hastaneden çıkış kreatinini yüksekliği ve erken cerrahi komplikasyonların gelişiminin allograft kaybını, kardiyovasküler hastalık gelişminin hasta kaybını artırdığı gösterilmiştir.