Kidney Transplant with Multi-organ and Mono-Organ Donor in Argentina 2007-2015. Results

Abstract

Purpose To analyze both patient and graft survival in Argentina in the last 9 years, in relation to mono-organ donors (kidney donor – KD) and multiorgan donor (multiorgan donor – MOD) and other associated variables. Materials and Methods 5788 patients older than 18 were assessed at the time of transplant (Tx) between January 1, 2007 and December 31, 2015 The variables used in the multivariate model were cause of death of the donor, donor type, donor´s age and gender, (CVA, TBI, Others), cold ischemia time (CIT), years on waiting list to transplant (< o > 3), years on dialysis to transplant (< o > 6), etiology at the time of listing, delayed graft function (DGF) defined as the need for dialysis within a 7-day period after transplant. Results The study included 5788 patients, 4.6% of the transplant procedures used mono-organ donors. The etiology of the patients undergoing transplantation was unknown (28%), glomerulonephritis (20%), nephroangiosclerosis (15%), diabetic nephropathy (8%), renal polycystic disease (12%) and Others (17%). Mean recipient and donor´s age was 51.6 years (CI 95% 51.0-52.0) and 45.9 years (CI 95% 45.3-46.6) respectively.Fifty six percent of the patients AND 58% of the donors were male10% of the patients, 578, required dialysis within the first 7 days after transplantation. Transplant patients receiving a kidney from a KD had DGF (11.1%), and 9% of the transplant patients receiving a kidney from a MOD had DGF, was not statistically significant. Mean time in years on waiting list was 2.9 (CI 95% 2.8 -3.0) and the mean time on dialysis to transplant was 6.3 (CI 95% 6.1-6.4). The main causes of donor´s death were CVA (56%) and TBI (36%). Post – transplant patient survival at one year with KD and MOD was 89.4% and 90.7%, at 3 years, 83.9% and 85.5%, at 5 years 78.9 % and 81.5%, and at 9 years 67.5% and 66.6%, respectively. Post- transplant graft survival with KD and MOD was 83.4 and 86.6% at one year; 74.1% and 78.2% at 3 years, 66.0% and 71.0% at 5 years, and 42.8% and 51.5% at 9 years, respectively. After comparing graft survival curves (log rank test) a P= 0.0002 was obtained. In the multivariate analysis: both donor and recipient ´s age, the time on dialysis and etiologies such as nephroangiosclerosis and diabetic nephropathy and DGF had a statistically significant association with post- transplant mortality. As for graft survival, the variables that were negatively associated were: donor and recipient´s age, diabetic nephropathy, years on dialysis before transplant and DGF. As for causes of death, TBI and Others were considered statistically significant as a protecting factor for graft loss in the post-transplant period. Conclusions The type of retrieval, although the Kaplan Meier curve shows a slightly improved survival for patients receiving a kidney from a MOD as compared to those receiving a kidney from a KD, is not statistically significant for patients; however, it is statistically significant for the graft.