Analysis of the effect of donor-related factors on organ and patient survival in renal transplantation patients with high postoperative donor creatinine, department of internal medicine, Gaziantep University, thesis of specialization in medicine,

Purpose: Chronic Kidney Disease (CKD) ranks among the prevalent diseases worldwide, causing significant morbidity and mortality while imposing a burden on national economies. CKD is irreversible, necessitating renal replacement therapies after the development of end-stage renal failure. Renal transplantation stands as the only curative treatment among these modalities. In our study, we aimed to investigate the impact of donor-related factors on the survey of the transplanted kidney in the recipient for renal transplantation. Materials and Methods: Data from 344 transplants performed between January 1, 2018, and June 15, 2022, at the Gaziantep University Medical Faculty Hospital Organ Transplantation Center were retrospectively reviewed for this study, and 232 patients meeting the study criteria were included. Donors' demographic data, body mass index (BMI), pre-transplant HgA1c, glomerular filtration rate (GFR), micrototal protein (MTP), renal resistive index, and postoperative GFR evaluations, along with recipients' kidney function results at 1 year, were extracted from the hospital automation system and patient records for all included donors. Results: The donors included in the study were divided into two groups based on the recipients' serum creatinine levels during the first year of follow-up (Group 1 (n=154): recipients with serum creatinine levels at or below 1,4 mg/dl, Group 2 (n=78): recipients with serum creatinine levels above 1,4 mg/dl at the 1-year mark). In Group 1, the average donor age (Mean±SD: 47,76 ± 13,79) was lower than that in Group 2 (Mean±SD: 56,2± 11,10) (p=0.007). In other words, recipients with higher average donor ages had higher serum creatinine levels at 1 year, indicating lower renal survival. Regarding HLA compatibility, the average HLA compatibility percentage was 45,48 ± 28,54 in Group 1, while it was 62,23 ± 22,59 in Group 2 (p=0.007). Contrary to expectations, a statistically significant difference in HLA compatibility was observed between the groups, with higher HLA compatibility associated with poorer renal survival. While there was no difference between the groups in terms of donors' preoperative serum creatinine and GFR values, the average serum creatinine levels at postoperative discharge were higher in Group 2 (Group 2 vs. Group 1; 1.15 ± 0.36 vs. 1,09± 0.24) (p=0.044), and the average GFR values were lower in Group 2 (Group 2 vs. Group 1; 68,47 ± 7,61 vs. 78,32 ± 3,84) (p=0.026). Recipients of donors with lower average GFR at postoperative discharge had worse renal function at 1 year. No significant relationship was found between other donor-related parameters (gender, BMI, HgA1c, MTP, and renal resistive index) and renal function at 1 year in recipients. Conclusion: In conclusion, our preoperative evaluations of donors revealed that donor age and postoperative donor GFR values have significant effects on the long-term renal function in kidney transplant recipients. Contrary to popular belief, the percentage of HLA compatibility had no effect on renal function. In light of these findings, the age of donor candidates and the careful assessment of undetectable renal reserve in routine examinations are crucial for successful transplants. Keywords: Renal transplantation, donor, organ survey, causes of mortality