Retrospective evaluation of the effect of preoperative immunosuppressive therapy on postoperative medical complications after kidney transplantation

Renal transplantation is one of the therapeutic approaches that is preferred for end-stage renal diseases (ESRD). The patients should be monitored within intensive immunosuppressive therapy during the period that follows the transplantation. However, immunosuppressive therapy might have some side effects such as infection, cardiovascular diseases, diabetes, osteoporosis, malignancy. Immunosuppressive therapies might also be an option during the preoperative period according to the etiology of renal disease; especially for glomerulonephritis. This study aims to evaluate whether the postoperative complication risk rises amongst the patients who received immunosuppressive therapy preoperatively in contrast with who did not. Amongst 1000 patients that have undergone renal transplantation between September 1999 and May 2018, patients who received preoperative immunosuppressive therapy (50 patients) were determined, then; patients, (with similar demographic features) who did not received preoperative immunosuppressive therapy, were gathered in another group and data of 100 patients in total were evaluated retrospectively. Demographic features of donors and hosts, dialysis and transplantation data of the hosts, coexisting diseases, immunosuppressive therapies, medical complications, postoperative laboratory test results were obtained from medical records. Basal creatinine values; rejection rates; frequency of cytomegalovirus (CMV), urinary infections, herpes zoster, and BK virus; the rates of development of hepatitis, pancreatitis, osteoporosis, osteonecrosis, cardiovascular diseases, polycythemia, and malignancy; and rates of parathyroidectomy were all evaluated and no significant differences were detected between the patients who received preoperative immunosuppressive therapy and who did not received. New-onset diabetes were significantly more common amongst the patients who received preoperative immunosuppressive therapy. Total periods of immunosuppressive therapy were evaluated between two groups of patients having postoperative complications or not; and no significant differences were detected in terms of CMV, urinary infections, herpes zoster, BK virus, hepatitis, diabetes, osteonecrosis, cardiovascular diseases, polycythemia, parathyroidectomy and development of malignancy. Total period of immunosuppressive therapy was longer amongst patients who had osteoporosis or pancreatitis. As a result, it should be kept in mind that complication risks could be higher amongst the patients receiving long-term immunosuppressive therapy before transplantation in comparison with the patients receiving immunosuppressive therapy only during postoperative follow-up. Available findings need to be improved by using studies that includes larger patient populations.