Factors Affecting Graft Survival among Patients Receiving Kidneys from Live Donors: A Single-Center Experience

Abstract

Introduction. The aim of this report is to study the graft and patient survival in a large cohort of recipients with an analysis of factors that may affect the final outcomes. Methods. Between March 1976 and March 2008, 1967 consecutive live-donor renal transplants were carried out. Various variables that may have an impact on patients and/or graft survival were studied in two steps. Initially, a univariate analysis was carried out. Thereafter, significant variables were embedded in a stepwise regression analysis. Results. The overall graft survival was 86.7% and 65.5%, at 5 and 10 years, respectively. The projected half-life for grafts was 17.5 years and for patients was 22 years. Five factors had an independent negative impact on graft survival: donor's age, genetic considerations, the type of primary immunosuppression, number of acute rejection episodes, and total steroid dose during the first 3 months after transplantation. Conclusions. Despite refinements in tissue matching techniques and improvements in immunosuppression protocols, an important proportion of grafts is still lost following living donor kidney transplantation, presumably due to chronic allograft nephropathy.

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“…Results similar to our ITT analysis were reported in a recent study of 1967 living-donor transplants using different immunosuppressive protocols; their 10-year graft survival rate was 77.8%. 10 The long-term numeric survival advantage of the SIR-based protocol in our study is supported by the 10-year data on 592 patients, where patient survival was 80% in patients receiving a combination of 80% Abbreviations: ITT, intention-to-treat; POT, patients on therapy reduced CyA + SIR, 73% received a combination of full-dose CyA + SIR, and only 68% on conventional CyA and MMF. 11 On the other hand, no positive effect of SIR on patient survival was observed in other trials.…”

Plasma cell‐rich acute rejections in living‐related kidney transplantation: a clinicopathological study of 50 cases

“…A number of determinants have been identified, both immunological and non‐immunological, that influence long‐term renal allograft outcomes in living and deceased donor transplants . Acute rejections (ARs), in spite of potent immunosuppression, remain a key determinant of long‐term graft outcomes . ARs with plasma cell‐rich infiltrates (PCARs) are being identified as a distinct entity and variant of ARs .…”

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“…11 Between 12 In a more recent report from 2013 on 1891 first graft patients versus 73 second graft patients, 5-year and 10-year graft survival rates were reported as 86% versus 90% and 65.1% versus 77.8%. 13 On the other hand, many trials have documented inferior graft outcomes with retransplant versus first transplant. Among 61 retransplanted patients between 1990 and 2010, inferior outcomes were as expected among elderly patients, hyperimmunized recipients, and recipients with multiple surgical procedures at the site of last renal transplant.…”