Hippokratia 2004; 8(2):62-68
E. Koutlas, L. Nikolaidou-Tokalaki, G. Zacharakis
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece
Background: Survival after renal transplantation is the most important outcome measure when transplantation results are analysed. The determinators of patient and graft survival after renal transplantation are incompletely known and conflicting results have been reported. The purpose of this study was to evaluate the effect of common clinical parameters on patient and graft survival.
Material and Methods: Three hundred sixty three patients (pts), 235 men and 128 women, 39 years old (range 16-69), who received a first renal transplantation (Rt) from 1.1.1987 to 31.12.96, were studied. The influence of graft origin (LR or CD donor), method of dialysis (HD, PD), donor and recipient hypertension (DH, RH) before transplantation, delayed graft function (DGF), acute rejection (AR), recipient and donor sex on patient and graft survival was investigated. The methods Kaplan Meier, Log Rank, Breslow and Tarone Ware were used for statistical analysis.
Results: One and 5 year patient survival of the whole sample was 96.14% and 90.63% respectively. Pts with LRD or CD presented 1 and 5 survival 97.84%-95.24% and 93.13%-82.44% respectively (p:0.00005). Pts on HD or PD before Rt had 97.31%-92.59% and 90.74%-85.19% 1 and 5 year survival respectively (p:0.03). Pts with RH or not before Rt had 96.26%-90.37% and 98.39%-96.77% 1 and 5 year survival respectively (p:0.02). Pts with DH or not had 95.29%-83.33% and 98.92%-96.77% 1 and 5 year survival respectively (p:0.0015). One and 5 year graft survival (gs) of the whole sample was 87.33% and 68.60% respectively. Grafts from LRD or CD had 1 and 5 year survival 91.34%-72.73% and 80.94%-61.83% respectively (p:0.03). Grafts from DH or not had 1 and 5 year survival 88.10%- 64.29% and 96.77%-84.41% respectively (p:0.001). Grafts with DGF or not had 1 and 5 year survival 73.02%-55.56% and 91.67%-73.26% respectively (p:0.0001). Grafts with AR or not had 1 and 5 year survival 82.98%-48.94% and 89.52%-76.61% respectively (p:0.00005).
Conclusions: In conclusion better 5-year survival had pts with a LRD, previously on HD, without hypertension before Rt or a normotensive donor. Better survival presented grafts coming from a normotensive donor, a LRD, without DGF or AR.
Keywords: kidney transplantation, graft survival, patient survival, blood pressure, delayed graft function, acute rejection, donor age, recipient age, recipient sex, donor sex