Factors Having Effect on Graft and Patient Survival in Deceased DonorKidney Transplantation

Introduction and Objective: The frequency of end-stage renal disease which requiring renal replacement therapy (RRT) is increasing and this is an important public health problem. Kidney transplantation is the most outstanding RRT, but kidney transplant numbers, especially from deceased donors, are not at the desired level. It is important to know the factors affecting graft and patient survival in kidney transplants, in terms of contributing to graft and patient survival. In this study, we aimed to examine the factors affecting graft and patient survival in those who underwent kidney transplantation from deceased donor. Material and Method: We retrospectively analyzed 362 deceased donor kidney transplantation patients those had been performed in our institution from January 1, 2009 to December 31, 2019. Kaplan-Meier analysis was performed to evaluate graft and patient survival ratios. Using a multivariable Cox regression model, we evaluated the relationship between graft-patient survival and the factors such as age and gender of donor and recipient, body mass index of recipient and donor, duration of hemodialysis and acute rejection, etc. A p value less than 0.05 was considered statistically significant. Results: The recipients' mean age was 42 years. 167 (46,1%) of the recipients were female and 195 (53,9%) were male. The donors' mean age was 44 years. A total of 90 graft loss occurred during the follow-up period, 45 of which were caused by death and 55 patients died. Death uncensored graft survival rates were calculated as 92,5%, 80,1% and 66,9% at 1, 5 and 10 years, respectively. Recipient age, recipient history of coronary artery disease (CAD), donor age, donor history of cardiovascular disease (CVD) and acute rejection were determined as independent risk factors for uncensored graft survival. Death-censored graft survival rates were calculated as 96,1%, 90,3% and 81,7% at 1, 5 and 10 years, respectively. Male recipient, donor age, delayed graft function (DGF), and acute rejection were determined as independent risk factors for death-censored graft survival. Patient survival rates were calculated as 95,5%, 87,5% and 79,3% for 1, 5 and 10 years, respectively. In Kaplan-Meier analysis, the survival of those who were 45 years of age and over was significantly shorter than those who were younger than 45. Recipient age, recipient's history of CAD and acute rejection were found to be independent risk factors for patient survival. Conclusion: Recipient age, recipient's history of coronary artery disease (CAD), donor age, donor's history of cardiovascular disease (CVD) and acute rejection were determined as independent risk factors for uncensored graft survival. In death-censored analysis, the risk of graft loss increases in those with recipient male gender, advanced donor age, delayed graft function development, and acute rejection in follow-up. In Kaplan-Meier analysis, patient survival was found to be significantly shorter for those recipients aged 45 years and over than under 45 years. Recipient age, history of CAD and acute rejection were determined as independent risk factors for patient survival. Key Words: Deceased Donor, Kidney Transplantation, Patient and Graft Survival, Independent Risk Factors