Different Etiologies of Graft Loss and Death in Asian Kidney Transplant Recipients: A Report from Thai Transplant Registry (original) (raw)
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Risk Factors Associated With Graft Loss and Patient Survival After Kidney Transplantation
Transplantation Proceedings, 2009
Objective. To evaluate the influence of traditional risk factors on major kidney transplantation outcome. Patients and Methods. Data from kidney transplantation procedures performed between 2003 and 2006 were retrospectively analyzed for the influence of traditional risk factors on transplantation outcome. Of 2364 transplants, 67% were from living donors, 27% were from donors who met standard criteria, and 6% were from donor who met expanded criteria. Two hundred thirty-nine procedures (10%) were performed in pediatric patients. Immunosuppression was selected on the basis of subgroup population. Results. At 1 year posttransplantation, cumulative freedom from a treated acute rejection episode (ARE) was 76.7%, with no difference between black vs nonblack recipients (75.0% vs 73.4%; P ϭ .79). At 2 years, survival for patients (95.3% vs 88.3% vs 82.1%; P Ͻ .001) and grafts 92.3% vs 80.3% vs 70.9%; P Ͻ .001) was better in recipients of living donor grafts compared with donors who met standard or expanded criteria, respectively. Moreover, graft survival was poorer in black vs nonblack patients (83.6% vs 88.7%; P Ͻ .05) because of high mortality (13% vs 7%; PϽ.001). Risk factors associated with death included cadaveric donor organ (odds ratio [OR], 2.4) and black race (OR, 1.8), and risk factors associated with graft loss included cadaveric donor organ (OR, 2.
Death with Functioning Graft in Living Donor Kidney Transplantation: Analysis of Risk Factors
American Journal of Nephrology, 2003
Background: Death with a functioning graft (DWF) has been reported as a major cause of graft loss after renal transplantation. It has been reported to occur in 9-30%. Methods: From March 1976 to January 2002, a total of 1,400 living donor renal transplants were performed in our center. Out of 257 reported deaths among our patients, 131 recipients died with functioning grafts after a mean period of 53.4 B 53.2 months. Results: DWF patients account for 27% of all graft losses in our series. The mean age was 34.9 + 10.6 (range 8-62 years), 98 of them were male and 33 were female. The original kidney disease was GN in 9, PN in 24, PCK in 5 and nephrosclerosis in 8 patients. Acute rejection episodes were diagnosed in 84 patients (63.1). The post-transplant complications encountered were hypertension in 78 patients (59.5%), diabetes mellitus in 30 patients (22.9%), medical infections in 68 (51.5%), hepatic complications in 30 (22.9%) and malignancy in 17 patients (13%). The main causes of death in these patients were infections in 46 (35.6%), cardiovascular in 23 (17.6%), liver cell failure in 15 patients (11.4%) and malignancy in 8 (6.1%). The mean serum creatinine was 2 B 0.6 mg/dl at last followup before death. Conclusion: We conclude that the relatively higher mortality in renal transplantation is, in part, due to co-morbid medical illness, pre-transplant dialysis treatment, and factors uniquely related to transplantation, including immunosuppression and other drug effects. DWF must be in consideration when calculating graft survival.
Five preventable causes of kidney graft loss in the 1990s: A single-center analysis1
Kidney International, 2002
Five preventable causes of kidney graft loss in the 1990s: A tic and intensive care, and treatment and prevention of single-center analysis. infectious diseases). Background. Despite improvements in immunosuppressive In spite of these advances, grafts continue to fail. In protocols and patient care, kidney allografts continue to fail. 1991, we reviewed the causes of graft loss at our insti-We studied causes of graft loss for primary kidney transplants tution in the 1980s versus the 1970s [1]. We noted that in the 1990s to determine major causes and potential interventions. graft loss to acute rejection and to infectious death had Methods. Causes of graft loss were reviewed for 1467 primarkedly decreased, but that chronic rejection and carmary kidney transplants done at our institution between Janudiovascular death had become the major causes of graft ary 1, 1990, and December 31, 1999. Graft loss for that entire loss. This observation led to clinical studies in which we population was studied and then the causes of loss selectively showed that an acute rejection episode is the major risk examined at Ͻ1 year, 1 to 5 years, and Ͼ5 years post-transplant. factor for biopsy-proven chronic rejection [2, 3], that the Finally, causes of loss in the 1990s versus the 1980s were compared. incidence of early post-transplant acute rejection could Results. Five major causes of graft loss were noted in the be reduced by maintaining higher immunosuppressive 1990s: thrombosis, acute rejection (either alone or combined drug levels [4, 5], and that a decreased incidence of with delayed graft function or infection), chronic rejection, acute rejection is associated with a decreased incidence death with function, and noncompliance. In the first year postof chronic rejection [6]. transplant, thrombosis (25%) and death with function (41%) During the last ten years, patient care and immunosupwere the major causes of graft loss. After the first year, chronic rejection and death with function predominated. For recipients pressive protocols have changed significantly. Numerous dying with graft function, cardiovascular disease was the major new immunosuppressive agents have been approved for cause of death. induction and maintenance therapy and for treatment Conclusions. This study identified the five major causes of of rejection. However, because of improved transplant kidney graft loss in the 1990s. Different interventions are reoutcome, acceptance criteria for transplant candidates quired to decrease loss from each of these causes. Future rehave been expanded. Older as well as higher-risk candisearch needs to be directed at such interventions.
Transplantation Proceedings, 2017
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], 1.84e22.05; P ¼ .004), older transplant age (HR, 1.05; 95% CI, 1.02e1.08; P < .001), and high serum creatinine level at 6 months posttransplantation (HR, 1.74; 95% CI, 1.48e2.03; P < .001), whereas younger donor age decreased risk (HR, 0.97; 95% CI, 0.95e1.00; P ¼ .019). Also, the Tac-based regimen had a 3.63-fold (95% CI, 1.47e8.97; P ¼ .005) lower risk factor than the CsA-based regimen, and 2.93-fold (95% CI, 1.13e7.63; P ¼ .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 ¼ .035). In Cox regression analysis at year 3, older transplantation age (HR, 1.20; 95% CI, 1.04e1.39; P ¼ .014) and serum creatinine level at month 6 post-transplantation (HR, 1.65; 95% CI, 1.42e1.90; P < .001) were significant risk factors for graft survival. Hemodialysis (HD) plus peritoneal dialysis (PD) treatment was 2.22-fold (95% CI, 1.08e4.58; P ¼ .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, 0.62e0.86; P < .001) was protective for graft survival, whereas older transplantation age (HR, 1.40; 95% CI, 1.20e1.64; P < .001) and serum creatinine level at month 6 of posttransplantation (HR, 1.39; 95% CI, 1.19e1.61; P < .001) were significant risk factors.
Graft survival analysis in kidney transplantation: a 12-year experience in a Thai medical center
Transplantation proceedings, 2004
To analyze graft survival and to find the factors that influence survival in kidney transplantation recipients, we performed an analytic retrospective study. A retrospective analysis was undertaken on records of all patients who underwent transplantation from December 25, 1990 to December 24, 2002. Survival studies were calculated using the Kaplan-Meier method. The outcome endpoints were death, redialysis, lost to follow-up, and study termination. One hundred thirty-eight operations (49 living-related kidney transplantations [LRKT] and 89 cadaveric kidney transplantations [CDKT])were recruited. Age of patients was 39.9 +/- 9.8 years (range, 9-57 years). The male to female ratio was 1.9:1. The waiting time was 24.25 +/- 25.2 months. Only 9 recipients had diabetes mellitus. The graft survival rate of the cadaveric group was slightly higher than the living related group: 90.65% vs 87.48%, 88.97% vs 85.05%, 83.04% vs 79.72%, and 76.65% vs 67.78% at 1, 2, 3, and 4 years, respectively (P ...
Trends in Transplantation, 2017
Background: The number of patients with ESRD is increasing and the gap between the demand for KT and available donors is widening. Thus deceased donation is very important to the donor pool for ESRD. Objectives: This study aims to determine the long term graft and recipient outcome of deceased donor renal transplantation at the National Kidney and Transplant Institute from 2002-2007 and to determine the donor and recipient factors that affect graft and recipient survival. Materials and Methods: This is a retrospective cohort of deceased donor KT from January 2002 to December 2007. Data were reviewed and collected from National Kidney and Transplant Institute medical records and the Philippine Renal Disease Registry (PRDR). Recipient and donor demographic profile were expressed as frequency counts, percentages and means with standard deviation. Kaplan Meier was used to determine graft and patient survival and logistic regression to establish correlation between certain factors and survival. Results: Among 1,598 KT, 1,488 were from living donors and 110 from deceased donors. In the study, 91 patients were included. The mean recipient age was 40.40 ± 11.8 years and 65.9% were males. The primary renal diseases were chronic glomerulonephritis (63.7%), diabetic nephropathy (18.7%) and hypertensive nephrosclerosis (6.6%). Around 39.6% had 3 HLA mismatches and 61.5% had at least 1 DR match. Majority received induction therapy (90.1%) and 64.8% had tacrolimus based immunosuppressive regimen. The patient survival rate at 1 st , 3 rd , 5 th and 7 th years was 91%, 89%, 86% and 86% while graft survival was 89%, 79%, 73% and 68% respectively. Infection was the leading cause of death. Cold ischemia time was significantly associated with patient survival (P=0.033) while patients with male donors had significantly better graft survival (P=0.001). Conclusion: There was an acceptable outcome of KT from deceased donors up to 7 years post KT.
Nephrology Dialysis Transplantation, 2012
Background. To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age. Methods. The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. Results. Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. Conclusions. Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.
Liver Transplantation, 2014
Limited data are available for outcomes of simultaneous liver-kidney (SLK) transplantation using donation after cardiac death (DCD) donors. The outcomes of 12 DCD-SLK transplants and 54 SLK transplants using donation after brain death (DBD) donors were retrospectively compared. The baseline demographics were similar for the DCD-SLK and DBD-SLK groups except for the higher liver donor risk index for the DCD-SLK group (1.8 6 0.4 versus 1.3 6 0.4, P 5 0.001). The rates of surgical complications and graft rejections within 1 year were comparable for the DCD-SLK and DBD-SLK groups. Delayed renal graft function was twice as common in the DCD-SLK group. At 1 year, the serum creatinine levels and the iothalamate glomerular filtration rates were similar for the groups. The patient, liver graft, and kidney graft survival rates at 1 year were comparable for the groups (83.3%, 75.0%, and 82.5% for the DCD-SLK group and 92.4%, 92.4%, and 92.6% for the DBD-SLK group, P 5 0.3 for all). The DCD-SLK group had worse patient, liver graft, and kidney graft survival at 3 years (62.5%, 62.5%, and 58.9% versus 90.5%, 90.5%, and 90.6%, P 5 0.03 for all) and at 5 years (62.5%, 62.5%, and 58.9% versus 87.4%, 87.4%, and 87.7%, P < 0.05 for all). An analysis of the Organ Procurement and Transplantation Network database showed inferior 1-and 5-year patient and graft survival rates for DCD-SLK patients versus DBD-SLK patients. In conclusion, despite comparable rates of surgical and medical complications and comparable kidney function at 1 year, DCD-SLK transplantation was associated with inferior long-term survival in comparison with DBD-SLK transplantation.