Kidney Transplantation at a Southern Brazilian University Hospital: A 35-Year Practice Review.

Abstract

The Nephrology Unit at São Lucas Hospital, a University Hospital in Southern Brazil, has recently reached 35 years since its first kidney transplant. Few centers in the area have made a longitudinal analysis of processes, problems, grafts, and patient survival changes along this time. A single-center, retrospective study was performed. Data were separated into different eras, based on the nature of immunosuppression used: pre-cyclosporine (1978-1986), cyclosporine (1987-1997), mycophenolate introduction (1998-2002), new immunosuppressant drugs (2003-2007), and the current period (2008-2013). Between April 27, 1978, and April 30, 2013, 1231 transplants were performed. Significant differences were detected among different eras. The number of transplants has been progressively increasing, to include significantly older recipients (and donors), at a longer waiting list time, receiving organs that underwent longer cold ischemia time (P< .001). Yet, fewer acute rejection episodes and lower incidence of myocardial infarction and post-transplant diabetes mellitus (P< .001) were detected. In the present era, patient survival at 1, 3, and 5 years is 98.3%, 94.6%, and 90.5% respectively, for living donors, and 92.4%, 87.2%, and 80.7% for deceased donors, respectively. Living donor graft survival is 92.2%, 88.7%, and 82.4%, respectively, whereas deceased donor survival is 80.4%, 71.1%, and 63.7%, respectively. This retrospective analysis has significant historical value. It assembles and depicts a long follow-up period of a transplant series at a single Brazilian center. Throughout the eras, organ and patient survival increased, with fewer rejection episodes or complications, yet with overall decreased graft function.