Survival Analysis After Kidney-Pancreas and Kidney Transplant in Argentina

Abstract

Objective To assess survival after kidney-pancreas and kidney transplantation (Tx) using monorgan donors (P- Donor) and with pancreas retrieval (P+ Donor), in patients over the age of 18 in Argentina. Material and Methods The information about both kidney and kidney-pancreas transplant patients was obtained from SINTRA, or the period June 1, 1998 - December 31, 2015. Results 2303 patients were assessed, 58%were males.They received a kidney from a P+ donor, and 606 (26%) received a kidney-pancreas transplant. The median age of the kidney-pancreas recipients was 36.9, and 49.3 for P-, and 42.9 for P+ recipients. KP (kidney pancreas) donors had an average BMI of 23.7 < than kidney donors, whose values were 25.4 for P+ D, and 26.7 for P- D. 92% of the KP recipients had 0% PRA, whereas kidney transplant recipients were 90% for P+ D, and 91% for P-D. Patient survival at one year per group was as follows: 95% P+, 92%P- and 88% KP;and at five years 90% P+,83% P-y 76% KP. Overall survival for kidney grafts was 95% at 30 days; 88% at one year, and 70% at five years. Cox regression analysis for patient survival showed that recipient´s age >35evidenced a HR of 1.84 (CI 95% 1.34-2.52) p=<0.0001. The multivariate analysis showed that KP recipients had a HR of 2.7 (CI 95%1.48-4.93) as compared to kidney recipients, P+ and HR was 2.64 (CI 95%1.79-3.89) as compared to kidney recipients,P-. Recipient´s age >35 and a donor´s BMI >25 were associated with <patient´s survival, which was statistically significant; RP vs renal P+ y RP vs renal P-. When comparing KP transplant patients with kidney recipients, P-, more than 4 years on dialysis at the time of transplant was a risk factor with an HR of 1.43 (CI 95% 1.03-1.98). In the univariate analysis in kidney graft survival, donor´s BMI>25, CI time longer than 24 hours, CVA as the cause of death were unfavorable variables. Conclusions Although the variables related to both donor and recipient in kidney pancreas transplant show a more favorable scenario, patient´s survival in this groupis the lowest compared to other groups. This might be due to the presence of more comorbidity variables at the time of dialysis initiation and diabetes mellitus as the cause of kidney failure.