Long-term allograft survival after kidney transplantation.

BACKGROUND: Technical and medical advances over the past few years have produced an important increase in the functionality of renal allografts. The aim of this study was to identify the factors associated with allograft survival 15 years after transplantation in our series. METHODS: A retrospective study of kidney transplantations was carried out at Reina Sofia Hospital in Cordoba from February 1979 to December 1997, with follow-up through June 2012. A subanalysis of the series was undertaken, and Kaplan-Meier analysis and Cox proportional hazards model regression used to achieve the main objective of the study. RESULTS: A total of 487 renal allografts with a mean follow-up of 114 months were studied, of which 37% (n = 180) survived for >15 years. Of the 180 patients, the main causes of graft failure were chronic allograft nephropathy in 29 (66%) and patient death in 13 (29.5%). Multivariate analysis identified the number of HLA mismatches (hazard ratio [HR] 1.25, 95% CI 1.01-1.56), panel reactive antibodies (HR 2.61, 95% CI 1.28-5.26), and delayed graft function (HR 11.25, 95% CI 1.33-95.28) as being significantly associated with graft loss after 15 years. CONCLUSIONS: The high immunologic risk of the patients was independently associated with graft loss. Delayed graft function was the most important factor in the speed of graft failure beyond 15 years.

Variations in initial renal transplant function by type of organ retrieval.

BACKGROUND: Numerous factors have been associated with early delay in kidney function and thence the graft survival. However, few data are derived from different types of donation: single or multiorgan. Our goal was to analyze the association of type of retrieval with the early function of the renal graft. METHODS: A retrospective analysis of transplantations performed in the Reina Sofia Hospital from January 2004 to June 2012 from local deceased donors was carried out. We performed a descriptive analysis of the variables and univariate and multivariate analyses with the use of logistic regression to determine the association of type of retrieval (kidney-only [KO], kidney-liver [KL], and multiorgan [MO]) with delayed graft function (DGF) and early graft failure (EGF). RESULTS: We analyzed 287 kidney transplantations from 182 deceased donors, of which 25 (13.7%) were KO, 80 (43.9%) KL, and 77 (42.3%) MO. DGF was higher in MO retrievals compared with KL and KO (25.8% vs 24% vs 20.5%), though without reaching significance (P = .81). EGF at 3 months was 17.6% in KO compared with 10.5% in KL and 5.3% in MO (P = .2). Regarding DGF, in the multivariate analysis, donor age (P = .049) and donor sex (P = .029) appeared to be related to DGF. There were no differences by type of retrieval. Multivariate logistic regression analysis established a significant relationship between KO retrieval and EGF at 3 months (P = .005) compared with MO. CONCLUSIONS: Early graft function at 3 months decreases when the allograft is from KO retrievals compared with MO, probably related to the more unfavorable characteristics of these donors and their corresponding recipients.

Correlation between dual kidney biopsy in expanded-criteria donors and transplant survival.

OBJECTIVE: The aim was to study the relation between same-donor renal biopsies and analyze whether the score influences graft survival. METHODS: We retrospectively reviewed histologic results of expanded-criteria donors and the graft survival in patients followed at Reina Sofia Hospital (Cordoba, Spain) from January 2004 to October 2012. We analyzed clinical and demographic variables from the donors, as well the association between the scores of same-donor biopsies who had different scores for each kidney and the graft survival with a t test for paired data. A Kaplan-Meier with log-rank test was performed between the higher-score and the lower-score groups. We excluded retransplantation and those who received a combined transplantation (liver or pancreas). RESULTS: We analyzed 168 kidneys that had been biopsied, from 84 donors. Of the whole sample, 35.7% (n = 30) had the same score for each kidney, whereas 64.3% (n = 54) had discrepancies. In this second group, 81.8% (n = 44) had a difference of 1 point, and the remaining 18.2% (n = 10) had a larger difference. Both kidneys were suitable for transplantation in 72.7% of cases (n = 40), only 1 in 14.5% (n = 8), and none in 12.7% (n = 7). For analyzing the survival of the paired kidneys there were 48 kidneys from 24 donors with a different score for each kidney. We observed a difference in favor of the better scores, with a difference of 11 months up to the time of the analysis (P = .045). We found no significant differences in the log-rank test between the survival rate for the group with a less favorable score (95% confidence interval [CI], 61.26-95.67) versus those with a more favorable score (95% CI, 66.76-93.03). CONCLUSIONS: A high percentage of biopsies had a different score for the 2 kidneys from the same donor. This difference was important for graft survival. We therefore recommend doing a biopsy of both kidneys.