First-year mortality in living donor kidney transplantation: twelve-year experience from a single center

Yıl 2021, Cilt: 4 Sayı: 3, 252 - 256, 21.05.2021

Özgür Merhametsiz Mehmet Emin Demir Murat Sevmis Murathan Uyar Sema Aktas Şinasi Sevmiş

https://doi.org/10.32322/jhsm.872230

Öz

Objective: The mortality was seen in the early period after kidney transplantation is one of the most undesirable consequences of kidney transplant treatment. This study was aimed to evaluate the factors affecting the 1st-year mortality in patients who underwent living donor kidney transplantation (LDKT) in our center.
Material and Methods: Adult patients who underwent LDKT developed mortality within the 1st-year in our center between 2008 and 2020. Mortality group and the control group are compared according to donor and recipient characteristics. The risk factors that have an adjusted effect on 1st-year mortality after kidney transplantation were evaluated by cox regression survival analysis.
Results: Total mortality incidence was 8.35% and the 1st-year mortality incidence was 1.67%. Median dialysis duration (13 months vs. 3 months) was longer in the mortality-group, p=0.022. Cardiovascular disease (CVD) was more common in the mortality-group (50% vs. 31.1%), p=0.037. Median HLA mismatch numbers was higher in the mortality-group (4 vs. 3), p=0.027. According to Model 1, in terms of 1st- year mortality, each 1 year increment in recipient's age increases the mortality by 1,034 times, and dialysis treatment increases the mortality 2.5 times. According to Model 2, in terms of 1st-year mortality, each 1 year increment in recipient's age increase the mortality by 1,039 times, dialysis treatment increases the mortality 2.8 times and each 1 mismatch increase in HLA mismatch numbers increases the mortality by 1.3 times. Receiver operating characteristic analysis showed that the moderate predictive power for recipient age was AUC 0.734 (95% CI 0.623-0.844, p <0.001) and the weak level predictive power AUC was for HLA mismatch 0.639 (95% CI 0.519-0.759, p = 0.030) in terms of 1st-year mortality.
Conclussion: This study presented that the 1st-year mortality results of our organ transplant center are similar to the national and international literature. We determined recipient age, dialysis treatment and HLA mismatch numbers as independent risk factors affecting 1st-year mortality after LDKT.

Anahtar Kelimeler

Living donor kidney transplantation, mortality, dialysis

Kaynakça

• Feehally J, Floege J, Tonelli M, Johnson RJ. Comprehensive Clinical Nephrology, 6th ed. Elsevier; 2019. P 939-940, 942-947.
• Düsing P, Zietzer A, Goody PR, et al. Vascular pathologies in chronic kidney disease: pathophysiological mechanisms and novel therapeutic approaches. J Mol Med (Berl) 2021; 99: 335-8.
• Sarnak MJ, Levey AS, Schoolwerth AC, et al. American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003; 42: 1050-65.
• Yazbek DC, de Carvalho AB, Barros CS, et al. Cardiovascular disease in early kidney transplantation: comparison between living and deceased donor recipients. Transplant Proc 2012; 44: 3001-6.
• Feehally J, Floege J, Tonelli M, Johnson RJ. Comprehensive Clinical Nephrology, 6th ed. Elsevier; 2019. P 1198-1205, 1213-1216.
• Türkiye’de, Nefroloji-Diyaliz ve Transplantasyon. Registry 2008. İstanbul: Pasifik Reklam ve Tanıtım Hizmetleri/Metris Matbaacılık, 2009 (Türk Nefroloji Derneği Yayınları).
• Türkiye’de, Nefroloji-Diyaliz ve Transplantasyon. Registry 2013. Ankara: Miki Matbaacılık San. ve Tic. Ltd. Şti., 2014 (Türk Nefroloji Derneği Yayınları).
• Türkiye’de, Nefroloji-Diyaliz ve Transplantasyon. Registry 2016. Ankara: Miki Matbaacılık San. ve Tic. Ltd. Şti., 2017 (Türk Nefroloji Derneği Yayınları).
• Türkiye’de, Nefroloji-Diyaliz ve Transplantasyon. Registry 2019. Ankara: Miki Matbaacılık San. ve Tic. Ltd. Şti., 2020 (Türk Nefroloji Derneği Yayınları).
• Hart A, Smith JM, Skeans MA, et al. Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2018 Annual Data Report. Am J Transplant 2020; 20: 20-130.
• Kramer A, Boenink R, Noordzij M, et al. The ERA-EDTA Registry Annual Report 2017: a summary. Clin Kidney J 2020; 13: 693-709.
• Wu DA, Robb ML, Forsythe JLR, et al. Recipient Comorbidity and survival outcomes after kidney transplantation: a UK-wide prospective cohort study. Transplantation 2020; 104: 1246-55.
• Fuggle SV, Allen JE, Johnson RJ, et al. Factors affecting graft and patient survival after live donor kidney transplantation in the UK. Transplantation 2010; 89: 694-701.
• Jay CL, Dean PG, Helmick RA, Stegall MD. Reassessing preemptive kidney transplantation in the United States: are we making progress? Transplantation 2016; 100: 1120-7.
• Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 2002; 13: 1358-64.
• Feehally J, Floege J, Tonelli M, Johnson RJ. Comprehensive Clinical Nephrology, 6th ed. Elsevier; 2019. P 967-971.