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Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant.

Abstract

OBJECTIVES

We investigated the impact of nonimmuno-logic factors on patient and graft survival after deceased-donor kidney transplant.

MATERIALS AND METHODS

All deceased-donor kidney transplants performed between January 2004 and December 2015 were included in our analyses. We used the independent t test to calculate significant differences between means above and below medians of various parameters.

RESULTS

All study patients (N = 205; 58.7% males) received antithymocyte globulin as induction therapy and standard maintenance therapy. Patients were free from infection, malignancy, and cardiac, liver, and pulmonary system abnormalities. Most patients (89.2%) were recipients of a first graft. Median patient age, weight, and cold ischemia time were 38 years, 65 kg, and 15 hours, respectively. Delayed graft function, diabetes mellitus, and hypertension occurred in 19.1%, 43.4%, and 77.9% of patients, respectively. The 1- and 5-year graft survival rates were 95% and 73.8%. Graft survival was not affected by donor or recipient sex or recipient diabetes or hypertension. However, graft survival was longer in patients who received no graft biopsy (8.2 vs 6.9 y; P = .027) and in those who had diagnosis of calcineurin inhibitor nephrotoxicity versus antibody-mediated rejection after biopsy (8.19 vs 3.66 y; P = .0047). Longer survival was shown with donors who had traumatic death versus cerebro-vascular accident (5.9 vs 5.3 y; P = .029) and donors below the 50th percentile in age (8.23 and 7.14 y; P = .0026) but less with donors who had terminal acute kidney injury (6.97 vs 8.16 y; P = .0062). We found a negative correlation between graft survival and donor age (P = .01) and 1-year serum creatinine (P = .01).

CONCLUSIONS

Donor age, cause of brain death, and acute kidney injury affected graft survival in our study cohort but not donor or recipient sex or posttransplant or donor blood pressure.

Authors+Show Affiliations

From the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31084585

Citation

Alenazi, Shahad Farhan, et al. "Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant." Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation, 2019.
Alenazi SF, Almutairi GM, Sheikho MA, et al. Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant. Exp Clin Transplant. 2019.
Alenazi, S. F., Almutairi, G. M., Sheikho, M. A., Al Alshehri, M. A., Alaskar, B. M., & Al Sayyari, A. A. (2019). Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant. Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation, doi:10.6002/ect.2018.0396.
Alenazi SF, et al. Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant. Exp Clin Transplant. 2019 May 14; PubMed PMID: 31084585.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant. AU - Alenazi,Shahad Farhan, AU - Almutairi,Ghada Mahaya, AU - Sheikho,Maha Ahmed, AU - Al Alshehri,Mona Ahmed, AU - Alaskar,Batool Mousa, AU - Al Sayyari,Abdullah Ahmed, Y1 - 2019/05/14/ PY - 2019/5/16/entrez JF - Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation JO - Exp Clin Transplant N2 - OBJECTIVES: We investigated the impact of nonimmuno-logic factors on patient and graft survival after deceased-donor kidney transplant. MATERIALS AND METHODS: All deceased-donor kidney transplants performed between January 2004 and December 2015 were included in our analyses. We used the independent t test to calculate significant differences between means above and below medians of various parameters. RESULTS: All study patients (N = 205; 58.7% males) received antithymocyte globulin as induction therapy and standard maintenance therapy. Patients were free from infection, malignancy, and cardiac, liver, and pulmonary system abnormalities. Most patients (89.2%) were recipients of a first graft. Median patient age, weight, and cold ischemia time were 38 years, 65 kg, and 15 hours, respectively. Delayed graft function, diabetes mellitus, and hypertension occurred in 19.1%, 43.4%, and 77.9% of patients, respectively. The 1- and 5-year graft survival rates were 95% and 73.8%. Graft survival was not affected by donor or recipient sex or recipient diabetes or hypertension. However, graft survival was longer in patients who received no graft biopsy (8.2 vs 6.9 y; P = .027) and in those who had diagnosis of calcineurin inhibitor nephrotoxicity versus antibody-mediated rejection after biopsy (8.19 vs 3.66 y; P = .0047). Longer survival was shown with donors who had traumatic death versus cerebro-vascular accident (5.9 vs 5.3 y; P = .029) and donors below the 50th percentile in age (8.23 and 7.14 y; P = .0026) but less with donors who had terminal acute kidney injury (6.97 vs 8.16 y; P = .0062). We found a negative correlation between graft survival and donor age (P = .01) and 1-year serum creatinine (P = .01). CONCLUSIONS: Donor age, cause of brain death, and acute kidney injury affected graft survival in our study cohort but not donor or recipient sex or posttransplant or donor blood pressure. SN - 2146-8427 UR - https://www.unboundmedicine.com/medline/citation/31084585/Nonimmunologic_Factors_Affecting_Long-Term_Outcomes_of_Deceased-Donor_Kidney_Transplant L2 - https://doi.org/10.6002/ect.2018.0396 DB - PRIME DP - Unbound Medicine ER -