Risk Factors Related to the Best Glomerular Filtration in Six Months after Renal Transplantation

Abstract

Introduction Renal transplantation is the ideal therapy proposal to most of patients with terminal chronic renal disease (TCRD), improving life quality, reducing mortality and offering higher life expectancy than dialysis. However, risk factors are associated with a bad evolution of renal function post transplant. Among those, immunological complications (graft rejection) or not immunological (surgical and infectious), cold ischemia time, HLA matching, sensitization and in addition to this, the demographic characteristics of the donor and acceptor. Objectives Establish the risk factors associated to the worsening of glomerular filtration rate on renal transplanted patients in a period of 6 months after the transplantation in a reference hospital in Salvador-BA, 2012-2016; describe the demographic and clinical profile of patients submitted to kidney transplantation; evaluate and associate the risk factors and their impact in glomerular filtration on the 2nd, 4th and 6th month of renal transplant. Methods Observational study, retrospective and descriptive where transplanted patients were included, in a reference hospital in Salvador-BA, from 01/01/2012 to 31/12/2016; the absence of medical records or information about demographic and clinical variables, in the first 6 months of transplantation and/or age inferior to 18 years old was excluding criteria. The study variables were demographic and clinical in addition to them variables related to immunological or not-immunological complications. Statistical Analysis Was depleted descriptive and analytical statistics, Student´s t test and chi-square, ANOVA with repetitive measures, Kolmogorov-Smirnov and logistic regression model. P-value of p≤0,05 was considered statistically significant and analyzes in SPSS. Ethical Aspects The research protocol was approved by the ethical and human research committee and the research was conducted by the Resolution 466/12 CONEP-CNS/MS. Results: The sample was 166 patients of which 103 (62,0%) was male, average age of 39,6 ± 12,3 years old, average cold ischemia time from donor of 37,1 ± 11,3 years old, being 139 (83,7%) donors with age of <50 years old and predominance of deceased donors 125 (75,3%). About the impact on clearance <60ml/min to the 6th month of transplant was verified the association of cytomegalovirus (p=0,035; p=0,019), immunological complications (p=0,003; p=0,046; p=0,002), average age of donor (38,8 ± 11,4; p=0,024), two compatibility (p=0,047; p=0,006), acceptor age (0,015), cytomegalovirus (p=0,025) and presence of two compatibility (p=0,024). Conclusion: The patients studied was predominant male, on their 4th decade of life. Was noticed the influence of immunological complications, a small number of compatibility HLA, advanced age of donor and infection by cytomegalovirus been significant to the worsening of renal function on different moments after transplantation.