Kidney Transplant: Survival Analysis and Prognostic Factors after 10 Years of Follow-Up

Abstract

The aim of this work is to analyse recipient and graft survival after kidney transplant in a three-year cohort and to identify predictive factors with up to 10 years of follow-up. Methods: retrospective consecutive cohort study of 250 kidney transplant recipients operated between 2010 and 2012. Multiorganic transplants and both dead-donor and living-donor transplants were included. Data were collected from electronic health records. A survival analysis was conducted using the Kaplan-Meier method and a Cox proportional-hazards multivariate model. Results: mean follow-up was 8.1 ± 3.2 years. Graft survival at 2, 5 and 10 years was 89.0%, 85.1% and 78.4% respectively. The multivariate model identified the following risk factors for graft loss: diabetic nephropathy (HR 3.2 CI95% [1.1–9.4]), delayed graft function (3.8 [2.0–7.4]), chronic kidney rejection (3.7 [1.2–11.4]), and early surgical complications (2.6 [1.4–5.1]). Conversely, combined transplant was found to be a protective factor for graft loss (0.1 [0.0–0.5]). Recipient patient survival was 94.3%, 90.0% and 76.6% at 2, 5 and 10 years respectively. The model identified the following mortality risk factors: older recipient age (1.1 [1.1–1.2]), combined transplant (7.6 [1.7–34.5]) and opportunistic infections (2.6 [1.3–5.0]). Conclusions: 10-year recipient and graft survival were 76.6% and 78.4% respectively. Main mortality risk factors were older recipient age, opportunistic infections and multiorganic transplant. Main graft loss risk factors were diabetic nephropathy, delayed graft function, chronic kidney rejection and early surgical complications.