Patient and graft survival in patients with renal transplantation

Introduction and Aim: Chronic kidney disease is a major public health problem worldwide with morbidity and mortality, reduced quality of life and high treatment costs. In end-stage renal disease, kidney transplantation is the most advantageous kidney replacement therapy. International guidelines recommend that centers should present their own survival data. We planned this study to reveal patient and graft survival data of kidney transplants performed at Ondokuz Mayıs University Faculty of Medicine. Materials and Methods: In our study, we retrospectively analyzed 425 patients aged ≥18 years at the time of transplantation who underwent both cadaveric and living kidney transplantation between September 2008 and January 2022 and who were followed up in Ondokuz Mayıs University Faculty of Medicine, Department of Nephrology. Kidney transplant patients were divided into cadaveric and living kidney transplant recipients and graft survival, overall patient survival, functional graft and death-related patient survival were analyzed. Factors affecting survival were also analyzed and p<0.05 was considered significant in statistical analyses. Results: Among the patients included in the study, 190 (%44,7) were female and 235 (%55,3) were male. The mean age was 41,07 (±12,05) years. Of the patients, 229 (%53,9) were cadaveric transplants and 196 (%46,1) were living transplants. 43 of 425 patients had non-fatal graft loss. Of the graft loss, 28 occurred in cadaveric and 15 in living transplants. The 1, 2, 5, 10-year graft survival rates for cadaveric transplants were %94,2, %93,7, %89,3 and %80,9, respectively. The 1, 2, 5, 10-year graft survival rates for living transplants were %99,0, %99,0, %97,1, and %85,1, respectively. For both living and cadaveric transplants, graft survival rates associated with graft loss not due to death were worse in the presence of biopsy-proven rejection. In our study, death occurred in 66 of the recipients with a functional graft. Death with functional graft was present in 42 cadaveric and 24 living transplant recipients. The 1, 2, 5 and 10-year functional graft death-related patient survival rates were %96,4, %96,4, %93,6 and %73,5, respectively, in living transplants and %94,1, %91,6, %84,9 and %70,9, respectively, in cadaveric transplants. In the study, 353 of the recipients were alive and 72 of them died. Forty-eight of cadaveric transplants and 24 of living transplants died. The 1, 2, 5, 10-year overall patient survival rates for living transplants were %97,4, %96,9, %94,8, %74,8, respectively. The 1, 2, 5, 10-year overall patient survival rates for cadaveric transplants were %92,9, %90,6, %83,6 and %69,3, respectively. In the final outcome, 72 (%16,9) of the patients died. The first 3 causes of death were as follows; 18 (%25) unknown cause, 16 (%22.22) Covid-19, 15 (%20.83) sepsis. Discussion and Conclusion: In our study, it was pleasing that both graft and patient survival rates of kidney transplant patients were at international standards. Although both patient and graft survival rates have improved over time, kidney transplant recipients continue to be a patient group with high morbidity and mortality rates due to immunosuppressive therapy. Therefore, follow-up of kidney transplant recipients in experienced centers, treatment compliance and management of complications are very important.