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Long term graft and recipient outcome of deceased donor renal transplantation at the National Kidney and Transplant Institute

Mark Javeson C. Tam

Fellow-in-training, Department of Adult Nephrology, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Concesa B. Cabanayan-Casasola

Consultant, Department of Adult Nephrology, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines

Romina A.Danguilan

Consultant, Department of Adult Nephrology, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines

DOI: 10.15761/TiT.1000230

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Abstract

Background: The number of patients with end-stage renal disease (ESRD) is increasing and the gap between the demand for kidney transplantation (KT) and available donors is widening. Thus, deceased donation is very important to the donor pool for ESRD.

Objectives: This study aims to determine the long-term graft and recipient outcome of deceased donor renal transplantation at the NKTI from 2002-2007 and to determine the donor and recipient factors that affect graft and recipient survival.

Materials and methods: This is a retrospective cohort of deceased donor KT from January 2002 to December 2007. Data were reviewed and collected from NKTI medical records and the Philippine Renal Disease Registry (PRDR). Recipient and donor demographic profile were expressed as frequency counts, percentages and means with standard deviation. Kaplan Meier was used to determine graft and patient survival and logistic regression to establish correlation between certain factors and survival

Results: Among 1,598 KT, 1488 were from living donors and 110 from deceased donors. 91 patients were included in this study. The mean recipient age was 40.40 ± 11.8 years and 65.9% were males. The primary renal diseases were chronic glomerulonephritis (63.7%), diabetic nephropathy (18.7%) and hypertensive nephrosclerosis (6.6%). Around 39.6% had 3 HLA mismatches and 61.5% had at least 1 DR match. Majority received induction therapy (90.1%) and 64.8% had tacrolimus-based immunosuppressive regimen. The patient survival rate at 1, 3, 5 and 7 years was 91, 89, 86 and 86 percent while graft survival was 89, 79, 73 and 68 percent respectively. Infection was the leading cause of death. Cold Ischemia Time was significantly associated with patient survival (P = 0.033) while patients with male donors had significantly better graft survival (P= 0.001)

Conclusion: There was an acceptable outcome of KT from deceased donors up to 7 years post KT.

Key words

Cadaveric donor kidney transplantation, graft survival, patient survival

Introduction

Kidney transplantation (KT) is the preferred treatment for end stage renal disease (ESRD). A successful transplant triples the life expectancy of a renal failure patient. The projected life expectancy with a transplant was 17.19 years compared with only 5.84 years on dialysis [1]. Hence, despite an initial higher risk of death, long-term survival for patients who underwent transplantation is significantly better compared with patients who remain on dialysis.

In addition, KT is more cost effective and improves quality of life. A study showed that the costs of patient therapy by hemodialysis is far greater than transplantation and its maintenance three and a half times costlier [2]. The difference in quality of life between dialysis and transplant patients is statistically significant with 18.12% greater in transplant patients. Another study showed that KT provides greater survival benefits to patients with end-stage renal disease, at less cost [3].

There is an increasing prevalence of ESRD and the demand for KT is increasing. Majority comprise living donation and unfortunately decease donation has not increas0065d at an equivalent rate to meet the demand for KT [4]. In the Philippines, there are 10,000-12,000 new cases of ESRD annually [5]. 50-60% will need KT but only 10% is done. Of those being transplanted, 90% from living donors and only 10% from deceased organ donation.

Various studies has been done in the Philippines regarding outcomes of deceased donor KT as shown in Table 1 [6-9]. These studies showed a remarkable improvement in the outcome of deceased donor KT.

Table 1. Studies on deceased donor kidney transplant in the Philippines.

Author

n

KT Period

Immunosuppression

Induction Therapy

Patient Survival

(%)

Graft Survival

(%)

Liquete [6]

50

1983 -

1988

CyA+pred

CyA+aza+pred

None

1 year – 96

3 year – 81

1 year – 72

5 year – 50

Magcalas [7]

228

1984- 1996

CyA+pred

CyA+aza+pred

none

1 year – 81

5 year – 60

10 year - 48

1 year – 70

5 year – 42

10 year – 22

Ninalga [8]

71

1995 -

2001

CyA+aza+pred (46.5%)

CyA+MMF+pred (46.5%)

Tacro+aza+pred (2.8%)

Tacro+MMF+pred (4.2%)

None (84.5%)

IL-2 blocker (15.5%)

1 year – 80

3 year – 69

1 year – 65

3 year – 48

 

Overio [9]

 

 

156

2007 -

2010

Tacrolimus based

(96.8%)

CyA based

(3.2%)

IL- 2 blocker

(62.2%)

Polyclonal antibody

(37.8%)

1 year – 94

3 year – 90

1 year – 97

3 year – 96

CyA: cyclosporine; pred: prednisone; aza: azathioprine; tacro: tacrolimus; MMF: mycophenolate mofetil

Objectives

General objectives

  1. To determine the long-term graft and recipient outcome of deceased donor renal transplantation at the National Kidney and Transplant Institute from 2002-2007
  2. To determine the donor and recipient factors that affect graft and recipient survival

Specific objectives

  1. To describe the recipients’ demographic profile
  2. To determine the incidence of graft and patient survival rate among recipients of deceased donor KT at 7 years post-KT
  3. To describe the recipients’ cause of mortality
  4. To identify donor and recipient factors that significantly influences graft and patient survival at 7 years post KT

Methodology

Research design

Retrospective cohort study

Study population

All patients ≥18 years of age who underwent primary deceased donor KT from January 2002 to December 2007 at the National Kidney and Transplant Institute were included in this study. Excluded were pediatric patients, foreigners and those who were lost to follow up for at least 12 months post KT.

Materials and methods

The following data were reviewed and collected from medical records and PRDR: a) recipients’ demographic characteristics such as age, gender, cause of kidney disease, presence of diabetes mellitus, immunosuppressive regimen, induction therapy and immunologic status (Panel reactive antibody (PRA), number of HLA-ABDR mismatches and HLA-DR mismatches); b) donor factors such as age, gender and cold ischemia time (CIT)

Patients were followed up to 7 years post-KT to determine graft and patient survival.

Definition of terms

  • Patient survival is the survival from the date of transplant until the date of death.
  • Graft survival is the presence of renal function adequate to prevent the patient from resuming maintenance dialysis.
  • Graft loss is patient’s permanent return to dialysis.

Statistical analysis

The demographic profile of recipients and donors were expressed as frequency count, percentage and mean with standard deviation. Kaplan meier was used to determine graft and patient’s survival rate. To establish correlation between certain factors and survival, logistic regression analysis was utilized.

Ethical consideration

Confidentiality of the subjects were maintained. Anonymity were ensured and each patient was assigned a case number.

Results

From January 2002 to December 2007, a total of 1,598 KT were performed at the  NKTI, 1488 (93.1%) were from living donors and 110 (6.9%) were from deceased donors. Among the 110 recipients of deceased grafts, 91 (82.7%) patients were included in this study and 19 (17.3%) patients were excluded due to the following reasons: 3 subjects were foreigners; 10 pediatric patients and 6 subjects had incomplete data.

Demographic characteristics

The mean recipient age was 40.40 ± 11.8 years and 65.9% were males. The primary renal diseases were chronic glomerulonephritis (63.7%), diabetic nephropathy (18.7%) and hypertensive nephrosclerosis (6.6%). Around 39.6% had 3 HLA mismatches and 61.5% with at least 1 DR match. Majority received induction therapy (90.1%) and 64.8% had tacrolimus-based immunosuppressive regimen (Table 2).

Table 2. Demographic profile of recipients.

Characteristics

Frequency

Percentage

Age (years)

Less than 50 years old

71

78.0

50 years old and above

20

22.0

Gender

Male

60

65.9

Female

31

34.1

Presence of Diabetes Mellitus

Yes

14

15.4

No

77

84.6

Primary Renal Disease

Chronic glomerulonephritis

58

63.7

Diabetic nephropathy

17

18.7

Hypertensive nephrosclerosis

6

6.6

Chronic pyelonephritis

3

3.3

Autosomal dominant polycystic kidney disease

5

5.5

Others

2

2.2

Number of HLA-ABDR Mismatch

0

1

1.1

1

6

6.6

2

21

23.1

3

36

39.6

4

18

19.8

5

9

9.9

Number of DR Matches

0

24

26.4

1

56

61.5

2

11

12.1

Panel Reactive Antibody (PRA)

Class 1 >20%

2

3.6

<20%

54

96.4

Class 2 >20%

0

0

<20%

56

100

No data

35

 

Immunosuppressive Agents

Tacrolimus-based

59

64.8

CyA-based

27

29.7

 

Sirolimus- based

5

5.5

Induction Therapy

None

9

9.9

Basiliximab

53

58.2

 

Daclizumab

5

5.5

 

Alemtuzumab

24

26.4

Graft and patient outcome

The survival rate at 1, 3, 5 and 7 years for patients was 91, 89, 86 and 86 percent while graft survival was 89, 79, 73 and 68 percent respectively (Figure 1 and Figure 2). The leading cause of death was infection (76%) followed by cardiovascular disease (14%). Most of the death occurred less than 5 years post-KT (Table 3).

Figure 1. Kaplan Meier patient survival rate.

Figure 2. Kaplan Meier graft survival rate.

Table 3. Causes of Death.

Cause of Death

Frequency

(n = 13)

Percentage

Period of Death Post-KT

(years)

< 5

≥ 5

Infection Pneumonia (10)

10

76.9

9

1

Cardiovascular

2

15.4

1

1

Pulmonary Embolism

1

7.7

1

0

Factors associated with graft and patient survival at 7 years post-kidney transplant

There were no recipient factors that was significantly associated with graft and patient survival at 7 years post-KT (Table 4 and Table 5).

Table 4. Recipient Factors influencing 7-years patient survival.

Patient Survival

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Recipient Age

Less than 50 y/o (n=71)

9

62

6.465

0.784

0.376

50 y/o and above (n=20)

4

16

5.8

   

Recipient Gender

Female (n=31)

4

27

6.29

0.058

0.809

Male (n=60)

9

51

6.333

   

Primary Renal Disease

Glomerulonephritis (n=58)

9

49

No estimates were computed because most cases were censored.

1.833

0.872

Diabetic Nephropathy (n=17)

3

14

HPN (n=6)

1

5

CPN (n=3)

0

3

APKD (n=5)

0

5

others (n=2)

0

2

DM

yes (n=14)

2

12

6.143

0.001

0.977

no (n=77)

11

66

6.351

   

Induction

 

none (n=9)

0

9

No estimates were computed because most cases were censored.

1.582

0.208

with induction (n=82)

13

69

     

Immunosupression(ISA)

CYA base (n=27)

6

21

No estimates were computed because most cases were censored.

2.468

0.291

Tacrolimus base (n=59)

7

52

     

Sirolimus base (n=5)

0

5

     

PRA I

<20% (n=54)

7

47

No estimates are computed because most cases are censored.

0.283

0.595

>20% (n=2)

0

2

     

PRA II

<20% (n=56)

>20% (n=0)

7

49

6.393

No comparison analysis was performed because the factor variable had only one value for every stratum.

DR Match

0 (n=24)

4

20

6.25

0.417

0.812

1 (n=56)

7

49

6.429

   

2 (n=11)

2

9

5.909

   

AB Mismatch (MM)

0 (n=1)

0

1

No estimates were computed because most cases were censored.

4.328

0.503

1 (n=6)

1

5

2 (n=21)

4

17

3 (n=36)

7

29

4 (n=18)

0

18

5 (n=9)

1

8

Table 5. Recipient Factors influencing 7-years graft survival.

Graft Survival

 

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Recipient Age

Less than 50 y/o (n=71)

24

47

5.592

1.906

0.167

50 y/o and above (n=20)

3

17

6.231

   

Recipient Gender

         

Female (n=31)

8

23

5.903

0.374

0.541

Male (n=60)

19

41

5.621

   

PRD- Renal Disease

Glomerulonephritis(n=58)

17

41

5.817

1.222

0.943

Diabetic Nephropathy (n=17)

6

11

5.223

   

HPN (n=6)

1

5

6

   

CPN (n=3)

1

2

5.333

   

APKD (n=5)

1

4

5.8

   

Others (n=2)

1

1

6.5

   

DM

Yes (n=14)

5

9

5.13

0.541

0.462

No (n=77)

22

55

5.823

   

Induction

None (n=9)

1

8

6.444

1.558

0.212

With induction (n=82)

26

56

5.641

   

Immunosupression(ISA)

CYA base (n=27)

9

18

5.453

0.488

0.783

Tacrolimus base (n=59)

16

43

5.768

   

Sirolimus base (n=5)

2

3

6.6

   

PRA I

<20% (n=54)

18

36

5.613

0.05

0.824

>20% (n=2)

1

1

7

   

PRA II

<20% (n=56)

>20% (n=0)

 

 

 

 

 

19

 

 

 

 

 

37

5.663

No comparison analysis is performed because the factor variable has only one value for every stratum.

DR Match

0 (n=24)

6

18

6.009

0.553

0.758

1 (n=56)

17

39

5.665

   

2 (n=11)

4

7

5.364

   

AB MM

0 (n=1)

 

 

 

0

 

 

 

1

No estimates are computed because most cases are censored.

5.806

0.326

1 (n=6)

0

6

   

2 (n=21)

7

14

   

3 (n=36)

14

22

   

4 (n=18)

5

13

   

5 (n=9)

1

8

     

Cold ischemia time was significantly associated with patient survival rate among the donor factors while the gender of the donor was significantly associated with graft survival rate.

The patient survival rate among patients was significantly different when grouped according to cold ischemia time. (Log Rank = 6.81, p=0.033). The cold ischemia time with less than 12 had highest estimated mean survival rate (6.83 years), followed by 12-24 CIT (6.46 years). Patients with CIT greater than 24 had the lowest estimated survival rate (5.52 years) (Table 6). Graft survival of patients was significantly different when grouped according to donor’s gender (Log Rank = 11.055, p=0.001). Patients who had male donors had significantly higher estimated survival rate (6.06 years) than patients with female donors (3.69 years) (Table 7).

Table 6. Donor factors influencing 7-years patient survival.

Patient Survival

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Donor Age

≤ 20 y.o (n=21)

1

20

6.714

4.605

0.1

21-40 y.o (n=61)

9

52

6.377

≥ 40 y.o (n=9)

3

6

5

Donor Gender

Female (n=13)

3

10

5.615

1.086

0.297

Male (n=78)

10

68

6.436

   

Cold Ischemia Time

<12 (n=24)

2

22

6.833

6.81

0.033

12- 24 (n=44)

4

40

6.455

>24 (n=23)

7

16

5.522

Table 7. Donor factors influencing 7-years graft survival.

Graft Survival

 

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Donor Age

≤ 20 y.o (n=21)

4

17

5.952

3.142

0.208

21-40 y/o (n=61)

19

42

5.841

≥ 40 y.o (n=9)

4

5

4.333

Donor Gender

Female (n=13)

8

5

3.692

11.055

0.001

Male (n=78)

19

59

6.06

Cold Ischemia Time

<12 (n=24)

6

18

6.417

0.674

0.714

12- 24 (n=44)

14

30

5.523

>24 (n=23)

7

16

5.348

Discussion

There has been continuous improvement in graft and patient survival from 1983 to 2010 [6-9] (Table 8).

Table 8. Graft and patient survival from 1983 to 2010.

Author

n

KT Period

Immunosuppression

Induction Therapy

Patient Survival

(%)

Graft Survival

(%)

Liquete [6]

50

1983 –

1988

CyA+pred

CyA+aza+pred

None

1 year – 96

3 year – 81

1 year – 72

5 year – 50

Magcalas [7]

228

1984- 1996

CyA+pred

CyA+aza+pred

None

1 year – 81

5 year – 60

10 year – 48

1 year – 70

5 year – 42

10 year – 22

Ninalga [8]

71

1995 –

2001

CyA+aza+pred (46.5%)

CyA+MMF+pred (46.5%)

Tacro+aza+pred (2.8%)

Tacro+MMF+pred (4.2%)

None (84.5%)

IL-2 blocker (15.5%)

1 year – 80

3 year – 69

1 year – 65

3 year – 48

Tam

91

2002-2007

Tacrolimus based (64.8%)

CyA based (29.7%)

Sirolimus based (5.5%)

None (9.9%)

IL-2 blocker (58.2%)

Monoclonal antibody (31.9%)

1 year – 91

3 year – 89

5 year – 86

7 year - 86

1 year – 89

3 year – 79

5 year – 73

7 year - 68

 

Overio [9]

 

 

156

2007 –

Tacrolimus based

(96.8%)

CyA based

(3.2%)

IL- 2 blocker

(62.2%)

Polyclonal antibody

(37.8%)

1 year – 94

3 year – 90

1 year – 97

3 year – 96

CyA: cyclosporine; pred: prednisone; aza: azathioprine; tacro: tacrolimus; MMF: mycophenolate mofetil

Our study showed an improvement in graft survival when compared to studies done from 1983 to 2001 probably due to the improved immunosuppressive regimen, use of induction therapy and shorter CIT. When compared with the United States Renal Data System (USRDS) of 2013, our study was comparable in which their 1, 3 and 5 year patient survival rate were 94%, 86.6% and 75.5% while graft survival rates were 91.8%, 82.6% and 70.5% respectively [10].

Infection (76.9%) was the most common cause of death in our study followed by cardiovascular disease (15.4%). Compared to the United States Renal Data System (USRDS) wherein the most common cause of death is cardiovascular disease (31%) followed by infection (19%) and malignancies (10%) [10]. However, in a study in India of 160 deceased donor KT between 2006-2009, the most common cause of death was infection which was comparable to our study [11]. Factors for the high incidence of infections were unhygienic conditions, late presentation and diagnosis, high cost of life-saving antimicrobial agents and lack of sensitive and specific diagnostic tools that were either not available or were too expensive [11,12].

Among the recipient and donor factors studied, the donor’s gender was noted to affect the 7-year graft survival in which male donor had better outcome than female (p value = 0.001). This was similar to the study involving 464 renal transplant centers in Europe in which both patient and graft survival were worse with a female donor. Graft survival in female recipients of male donors was 48.4 ± 0.4 year vs. 46.9 ± 0.6 year for female donors (p value 0.0020). In male recipients, actuarial survival was 46.5 ± 0.3 year for male donors vs. 42.1 ± 0.5 year for female donors (p value < 0.0001). The assumption about the relative benefit of a male donor is that male kidneys have greater nephron number [13].

Patients with CIT of 12 hours had a significant patient survival. This is explained because there was less rejection with shorter CIT hence no need to give solumedrol pulsing hence no infection which is the main cause of patient mortality. The acute rejection with prolonged ischemia time could be reversed with solumedrol pulsing but could cause severe infection which may lead to death. United Network for Organ Sharing (UNOS) data noted a reduction in CIT during the 10-year period (1990-2000) with an overall reduction of 4.8 hour and noted improvement in 3-year graft survival (80% in 1996-2000 vs. 72% in 1990-1995 (p < 0.001) [14]. Another study showed that CIT had a significant effect on the 6-year graft survival, a 10-hour increase in CIT was associated with a hazard risk ratio (HRR) of 1.20 for graft failure (p < 0.001) [15]. In our study, CIT <12 hours showed better 7-year graft survival compared to CIT 12-24 hours and >24 hours however it did not achieved statistical significance. In contrast, CIT influence on patient survival achieved statistical significance (P value 0.033). CIT with less than 12 hours had highest estimated mean survival rate (6.83 years), followed by 12-24 hours CIT (6.46 years) and >24 hours CIT had the lowest estimated survival rate (5.52 years).

Conclusion

There was an acceptable outcome of KT from deceased donors up to 7 years post KT. The most common cause of death was infection followed by cardiovascular disease. Among the recipient and donor factors, the donor’s gender had effect on the 7-year graft survival in which male deceased donor KT had better graft survival compared to females and CIT was significantly associated with patient survival rate with CIT of less than 12 hours having better survival compared to CIT 12-24 hours and > 24 hours.

References

  1. Oniscu GC, Brown H, Forsythe JL (2005) Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol 16: 1859-1865. [Crossref]
  2. Perovic S, Jankovic S (2009) Renal Transplantation vs Hemodialysis: Cost-effectiveness Analysis. Vojnosanitetski Pregled 66(8): 639-644.
  3. Kalo Z, Jaray J (2001) Economic Evaluation of Kidney Transplantation versus Hemodialysis in Patients with End-Stage Renal Disease in Hungary. Prog Transplant September 11(3):188-193.
  4. Neylan JF, Sayegh MH, Coffman TM, Danovitch GM, Krensky AM, et al. (1999) The allocation of cadaver kidneys for transplantation in the United States: consensus and controversy. ASN Transplant Advisory Group. American Society of Nephrology. J Am Soc Nephrol 10: 2237-2243. [Crossref]
  5. Philippine Renal Registry 2010 Annual Report. Department of Health.
  6. Liquete R (1990) Long Term Outcome of Cadaveric Kidney Patients. Philippine Journal of Surgical Specialties 45(3): 99-101.
  7. Magcalas W, Liquete R (1996) Long Term Outcome of Cadaver Kidney Recipients. National Kidney and Transplant Institute Proceedings 1: 1-8.
  8. Ninalga HD, Danguilan R (2005) Graft and Recipient Outcome of Cadaveric Transplantation at the National Kidney and Transplant Institute from 1995-2001. National Kidney and Transplant Institute Proceedings 1: 63-70.
  9. Overio Y, Parayno A (2013) Graft and Recipient Outcome of Cadaveric Renal Transplantation at NKTI from 2007 to 2010 Unites States Renal Data System (USRDS) Annual Data Report. Renal Transplantation Vol. 2 Chapter 7: 283-294.
  10. Gumber MR, Kute VB (2011) Deceased Donor Organ Transplantation - A Single-Center Experience. Indian J Nephrol 21(3): 182-185.
  11. Jha V, Chugh S, Chugh KS (2000) Infections in Dialysis and Transplant Patients in Tropical Countries. Kidney Int 57 (Suppl 74): S585-S593
  12. Zeier M, Döhler B, Opelz G, Ritz E (2002) The effect of donor gender on graft survival. J Am Soc Nephrol 13: 2570-2576. [Crossref]
  13. Salahudeen AK, May W (2008) Reduction in cold ischemia time of renal allografts in the United States over the last decade. Transplant Proc 40: 1285-1289. [Crossref]
  14. Salahudeen AK, Haider N, May W (2004) Cold ischemia and the reduced long-term survival of cadaveric renal allografts. Kidney Int 65: 713-718. [Crossref]

Article Type

Research Article

Publication history

Received date: March 09, 2017
Accepted date: April 05, 2017
Published date: April 07, 2017

Copyright

© 2017 Tam MJC. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Tam MJC, Cabanayan-Casasola CB, Danguilan RA (2017) Long term graft and recipient outcome of deceased donor renal transplantation at the National Kidney and Transplant Institute. Trends in Transplantation 2: DOI: 10.15761/TiT.1000230

Corresponding author

Romina A.

Danguilan, Chair of the Department of Adult Nephrology, National Kidney and Transplant Institute, East Avenue, Diliman, 1101 Quezon City, Philippines, Tel: 6329810300, Fax: 6329810368

Figure 1. Kaplan Meier patient survival rate.

Figure 2. Kaplan Meier graft survival rate.

Table 1. Studies on deceased donor kidney transplant in the Philippines.

Author

n

KT Period

Immunosuppression

Induction Therapy

Patient Survival

(%)

Graft Survival

(%)

Liquete [6]

50

1983 -

1988

CyA+pred

CyA+aza+pred

None

1 year – 96

3 year – 81

1 year – 72

5 year – 50

Magcalas [7]

228

1984- 1996

CyA+pred

CyA+aza+pred

none

1 year – 81

5 year – 60

10 year - 48

1 year – 70

5 year – 42

10 year – 22

Ninalga [8]

71

1995 -

2001

CyA+aza+pred (46.5%)

CyA+MMF+pred (46.5%)

Tacro+aza+pred (2.8%)

Tacro+MMF+pred (4.2%)

None (84.5%)

IL-2 blocker (15.5%)

1 year – 80

3 year – 69

1 year – 65

3 year – 48

 

Overio [9]

 

 

156

2007 -

2010

Tacrolimus based

(96.8%)

CyA based

(3.2%)

IL- 2 blocker

(62.2%)

Polyclonal antibody

(37.8%)

1 year – 94

3 year – 90

1 year – 97

3 year – 96

CyA: cyclosporine; pred: prednisone; aza: azathioprine; tacro: tacrolimus; MMF: mycophenolate mofetil

Table 2. Demographic profile of recipients.

Characteristics

Frequency

Percentage

Age (years)

Less than 50 years old

71

78.0

50 years old and above

20

22.0

Gender

Male

60

65.9

Female

31

34.1

Presence of Diabetes Mellitus

Yes

14

15.4

No

77

84.6

Primary Renal Disease

Chronic glomerulonephritis

58

63.7

Diabetic nephropathy

17

18.7

Hypertensive nephrosclerosis

6

6.6

Chronic pyelonephritis

3

3.3

Autosomal dominant polycystic kidney disease

5

5.5

Others

2

2.2

Number of HLA-ABDR Mismatch

0

1

1.1

1

6

6.6

2

21

23.1

3

36

39.6

4

18

19.8

5

9

9.9

Number of DR Matches

0

24

26.4

1

56

61.5

2

11

12.1

Panel Reactive Antibody (PRA)

Class 1 >20%

2

3.6

<20%

54

96.4

Class 2 >20%

0

0

<20%

56

100

No data

35

 

Immunosuppressive Agents

Tacrolimus-based

59

64.8

CyA-based

27

29.7

 

Sirolimus- based

5

5.5

Induction Therapy

None

9

9.9

Basiliximab

53

58.2

 

Daclizumab

5

5.5

 

Alemtuzumab

24

26.4

Table 3. Causes of Death.

Cause of Death

Frequency

(n = 13)

Percentage

Period of Death Post-KT

(years)

< 5

≥ 5

Infection Pneumonia (10)

10

76.9

9

1

Cardiovascular

2

15.4

1

1

Pulmonary Embolism

1

7.7

1

0

Table 4. Recipient Factors influencing 7-years patient survival.

Patient Survival

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Recipient Age

Less than 50 y/o (n=71)

9

62

6.465

0.784

0.376

50 y/o and above (n=20)

4

16

5.8

   

Recipient Gender

Female (n=31)

4

27

6.29

0.058

0.809

Male (n=60)

9

51

6.333

   

Primary Renal Disease

Glomerulonephritis (n=58)

9

49

No estimates were computed because most cases were censored.

1.833

0.872

Diabetic Nephropathy (n=17)

3

14

HPN (n=6)

1

5

CPN (n=3)

0

3

APKD (n=5)

0

5

others (n=2)

0

2

DM

yes (n=14)

2

12

6.143

0.001

0.977

no (n=77)

11

66

6.351

   

Induction

 

none (n=9)

0

9

No estimates were computed because most cases were censored.

1.582

0.208

with induction (n=82)

13

69

     

Immunosupression(ISA)

CYA base (n=27)

6

21

No estimates were computed because most cases were censored.

2.468

0.291

Tacrolimus base (n=59)

7

52

     

Sirolimus base (n=5)

0

5

     

PRA I

<20% (n=54)

7

47

No estimates are computed because most cases are censored.

0.283

0.595

>20% (n=2)

0

2

     

PRA II

<20% (n=56)

>20% (n=0)

7

49

6.393

No comparison analysis was performed because the factor variable had only one value for every stratum.

DR Match

0 (n=24)

4

20

6.25

0.417

0.812

1 (n=56)

7

49

6.429

   

2 (n=11)

2

9

5.909

   

AB Mismatch (MM)

0 (n=1)

0

1

No estimates were computed because most cases were censored.

4.328

0.503

1 (n=6)

1

5

2 (n=21)

4

17

3 (n=36)

7

29

4 (n=18)

0

18

5 (n=9)

1

8

Table 5. Recipient Factors influencing 7-years graft survival.

Graft Survival

 

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Recipient Age

Less than 50 y/o (n=71)

24

47

5.592

1.906

0.167

50 y/o and above (n=20)

3

17

6.231

   

Recipient Gender

         

Female (n=31)

8

23

5.903

0.374

0.541

Male (n=60)

19

41

5.621

   

PRD- Renal Disease

Glomerulonephritis(n=58)

17

41

5.817

1.222

0.943

Diabetic Nephropathy (n=17)

6

11

5.223

   

HPN (n=6)

1

5

6

   

CPN (n=3)

1

2

5.333

   

APKD (n=5)

1

4

5.8

   

Others (n=2)

1

1

6.5

   

DM

Yes (n=14)

5

9

5.13

0.541

0.462

No (n=77)

22

55

5.823

   

Induction

None (n=9)

1

8

6.444

1.558

0.212

With induction (n=82)

26

56

5.641

   

Immunosupression(ISA)

CYA base (n=27)

9

18

5.453

0.488

0.783

Tacrolimus base (n=59)

16

43

5.768

   

Sirolimus base (n=5)

2

3

6.6

   

PRA I

<20% (n=54)

18

36

5.613

0.05

0.824

>20% (n=2)

1

1

7

   

PRA II

<20% (n=56)

>20% (n=0)

 

 

 

 

 

19

 

 

 

 

 

37

5.663

No comparison analysis is performed because the factor variable has only one value for every stratum.

DR Match

0 (n=24)

6

18

6.009

0.553

0.758

1 (n=56)

17

39

5.665

   

2 (n=11)

4

7

5.364

   

AB MM

0 (n=1)

 

 

 

0

 

 

 

1

No estimates are computed because most cases are censored.

5.806

0.326

1 (n=6)

0

6

   

2 (n=21)

7

14

   

3 (n=36)

14

22

   

4 (n=18)

5

13

   

5 (n=9)

1

8

     

Table 6. Donor factors influencing 7-years patient survival.

Patient Survival

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Donor Age

≤ 20 y.o (n=21)

1

20

6.714

4.605

0.1

21-40 y.o (n=61)

9

52

6.377

≥ 40 y.o (n=9)

3

6

5

Donor Gender

Female (n=13)

3

10

5.615

1.086

0.297

Male (n=78)

10

68

6.436

   

Cold Ischemia Time

<12 (n=24)

2

22

6.833

6.81

0.033

12- 24 (n=44)

4

40

6.455

>24 (n=23)

7

16

5.522

Table 7. Donor factors influencing 7-years graft survival.

Graft Survival

 

Factors

No. of Events

Censored

Estimated Mean Survival (in years)

Log-rank Statistic Value

P-Value

Donor Age

≤ 20 y.o (n=21)

4

17

5.952

3.142

0.208

21-40 y/o (n=61)

19

42

5.841

≥ 40 y.o (n=9)

4

5

4.333

Donor Gender

Female (n=13)

8

5

3.692

11.055

0.001

Male (n=78)

19

59

6.06

Cold Ischemia Time

<12 (n=24)

6

18

6.417

0.674

0.714

12- 24 (n=44)

14

30

5.523

>24 (n=23)

7

16

5.348

Table 8. Graft and patient survival from 1983 to 2010.

Author

n

KT Period

Immunosuppression

Induction Therapy

Patient Survival

(%)

Graft Survival

(%)

Liquete [6]

50

1983 –

1988

CyA+pred

CyA+aza+pred

None

1 year – 96

3 year – 81

1 year – 72

5 year – 50

Magcalas [7]

228

1984- 1996

CyA+pred

CyA+aza+pred

None

1 year – 81

5 year – 60

10 year – 48

1 year – 70

5 year – 42

10 year – 22

Ninalga [8]

71

1995 –

2001

CyA+aza+pred (46.5%)

CyA+MMF+pred (46.5%)

Tacro+aza+pred (2.8%)

Tacro+MMF+pred (4.2%)

None (84.5%)

IL-2 blocker (15.5%)

1 year – 80

3 year – 69

1 year – 65

3 year – 48

Tam

91

2002-2007

Tacrolimus based (64.8%)

CyA based (29.7%)

Sirolimus based (5.5%)

None (9.9%)

IL-2 blocker (58.2%)

Monoclonal antibody (31.9%)

1 year – 91

3 year – 89

5 year – 86

7 year - 86

1 year – 89

3 year – 79

5 year – 73

7 year - 68

 

Overio [9]

 

 

156

2007 –

2010

Tacrolimus based

(96.8%)

CyA based

(3.2%)

IL- 2 blocker

(62.2%)

Polyclonal antibody

(37.8%)

1 year – 94

3 year – 90

1 year – 97

3 year – 96

CyA: cyclosporine; pred: prednisone; aza: azathioprine; tacro: tacrolimus; MMF: mycophenolate mofetil