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HERDIN Record #: PCHRD042707070410 Submitted: 28 April 2007 Modified: 12 October 2016

Graft and recipient outcome of cadaveric renal transplantation at the National Kidney And Transplant Institute from 1995-2001.

Enrique T. Ona,
Rose Marie R. Liquete,
Concesa C. Cassasola,
Yvette T. Tomacruz,
Hazel Daphne R. Ninalga

Objectives: This study aimed to determine the graft and patient survival among the recipients of cadaveric renal grafts at the National Kidney and Transplant Institute (NKTI) from 1995 to 2001 and to identify donor and recipient factors that affect graft survival. Methodology: This is a retrospective cohort study which included 71 adult recipients of primary cadaveric renal transplant. Donor and recipient data were gathered from hospital records and were expressed as ratios, percentages and means with standard deviation. Friedman Two-way ANOVA and logrank tests were utilized. Results: Graft survival at 3 months, 6 months, 1 year and 3 years were 83.1 percent, 76.7 percent, 65.0 percent and 48.3 percent, respectively. Immediate graft function was 78.87 percent while delayed graft function was 15.49 percent. Four patients (5.63 percent) had primary graft non-function Patient survival at 6 months, 1 year and 3 years were 85.9 percent, 80.3 percent and 69 percent, respectively. Sepsis was the most common cause of death (68.2 percent). Shorter cold ischemia time (less than or equal to 24 hours) was associated with better graft survival. On the other hand, the age, sex, cause of death and terminal creatinine of the donor did not affect graft survival. Among the recipient factors studied, only age and primary renal disease had an association with graft survival. Recipients who were 30 years of age or younger had better graft survival compared to those who were older. Chronic glomerulonephritis was associated with poorer graft survival. The recipients' sex, dialysis type and duration, induction therapy, initial immunosuppressive regimen and HLA matching with the donor had no association with graft survival. In the hope of further improving the graft and patient outcome in cadaveric renal transplantation, several donor and recipient factors have been identified as predictive of short and long-term graft and patient survival. Among the donor factors analyzed, young and old age (55 years of age), male gender, diabetes and hypertension were associated with poor 3-year graft survival. There was no relationship between the donor's terminal creatinine and graft survival. Among the recipient factors, older age, male gender, adult polycystic kidney disease and acute rejection were associated with poor patient outcome. A longer duration of renal replacement therapy prior to transplantation was associated with the development of primary graft non-function (PNF) but not with immediate graft function (IGF) and delayed graft function (DGF). Graft survival in those without acute rejection episodes was significantly better than those with one or more episodes (5.4 years vs 3.94 years median survival time). In fact, graft survival was inversely correlated to the number of episodes of acute rejection. In terms of long-term graft survival, the best outcome was seen in patients with good graft function (serum creatinine of less than 200 umol/L) at three months post-transplantation. In terms of patient outcome, those with PNF had poorer survival than those with DGF and IGF but there was no difference in survival between DGF and IGF. Preemptive transplant had the best 3-year graft survival followed by those with history of peritoneal dialysis and then hemodialysis. The number of pre-transplant transfusions did not significantly affect graft survival in bivariate analysis. The 3-year survival improved and declined in linear fashion with increasing number of matched and mismatched HLA antigens, respectively. In a retrospective study of 589 cadaveric renal transplants by Pirsch et al, they reported that graft loss was highest with greater DR mismatches, 2 B antigen mismatches, higher donor serum creatinine and younger recipient age. After transplantation, acute rejection was the most significant factor associated with long-term graft survival. They suggested that a combination of immediate graft function, prevention of acute rejection by appropriate early immunosuppression, and acceptable DR match enhances cadaveric graft survival. From 1983-2003,317 cadaveric kidney transplants were performed at the National Kidney and Transplant Institute. Of these, Liquete et al studied 50 cadaveric kidney transplants done in the Institute between December 1983 and August 1988. During this time, the patients were given either a combination of Cyclosporine and Prednisone (CYA-Pred) or Triple Therapy consisting of Cyclosporine, Azathioprine and Prednisone. Graft survival at 1 month, 1 year and 5 years were 84 percent, 72 percent and 50 percent respectively. This was comparable with the data from Belgium and UCLA during the same period. In the CYA-Pred group, the 6 month and 1 year graft and patient survival were all 96 percent. In the Triple Therapy Group, the 6 month graft and patient survival was 87 percent. At 1 year, it was 73 percent and 80 percent respectively. After the study of Liquete et al, no other local studies have been done to review how our transplant program has fared in the context of the recent dynamic changes in the field of transplantation. Therefore, the local graft and recipient outcomes and the factors affecting them in this era of new immunosuppression strategies need to be investigated.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Nephrology
Frequency
Semi-Annual
Publication Date
July-December 2005
Volume
20
Issue
2
Page(s)
111-115
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 53 Fulltext pdf (Request Document)