Patient and Graft Survival in Kidney Transplantation From Deceased Donors in Argentina, 1998-2011.

Abstract

To analyze both patient and graft survival in renal transplantation in adults receiving kidneys from deceased donors in Argentina. 5181 transplants were included in the analysis. The information was taken from SINTRA 1st January 1998 until 31 December 2011 with follow-up to April 9, 2012. The Kaplan-Meier method was used to estimate survival, and time was divided in two-year and three year periods, as follows:1998-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2009, 2010-2011.Tocompare the curves the log-rank test was used. The Cox regression model was used to analyze the effect of variables like age and gender of both donor and recipient, donor's cause of death (stroke,TBI,anoxia,other causes of coma and others),time on dialysis (<or> 7 years ), cold ischemia time (<or> 24 hours) and etiology of recipient's renal failure. Patient survival for the period 1998-2000 at 1 year was 89.6%, at 3 years 86.4% and 81.8% at 5 years. For the period 2001-2003 at 1 year was 90.8%, at 3 years 85.1% and at 5 years 79%. 2004-2006, at 1 year was 89.2%, at 3 years 81%, and at 5 years 74.1%. 2007-2009, at 1 year was 90.1%, at 3 years 84%, and at 5 years 76.7%. 2009-2010, at 1 year was 90.2%. Log rank 0.0583. Graft survival 1998-2000 at 1 year was 88.2%, at 3 years 82.1%, and at 5 years 75%. 2001-2003, at 1 year was 87.5%, at 3 years 79.5%, and at 5 years 70.8%. 2004-2006, at 1 year was 82.9%, at 3 years 72.1%, and at 5 years 62.5%. 2007-2009, at 1 year was 86%, at 3 years 76.3%, and at 5 years 66.3%. 2009-2010, at 1 year was 86.1%. Logrank 0.0004. The variables with statistical significance for graft survival were recipient's age 45-59 years HR 1.38 (1.22-1.57)> 60 years HR 1.90 (1.65-2.19), donor's age 45-59 years HR 1.22 (1.08-1.39)> 60 years HR 1.60 (1.34-1.91), time on dialysis> 7 years HR 1.31 (1.17-1.48), CIT>24hrs HR 1.13 (1.01-1.25), diabetic nephropathy as a cause of CRF HR 1.62 (1.31-2.01) A significant difference in graft survival curves with improved survival for the first three time periods was observed. Once the variables associated with a lower probability of survival were found the comparison of proportions showed that in the last period, 2010-2011, more recipients over> 60 years of age received a transplant, with more donors> 60 years and with more recipients with more than 7 years on dialysis. The CIT <24 h was more common the period 2010-2011, but was not enough to change the differences in survival.