Risk factors associated with graft loss and patient survival after kidney transplantation.
OBJECTIVE
To evaluate the influence of traditional risk factors on major kidney transplantation outcome.


METHODS
Data from kidney transplantation procedures performed between 2003 and 2006 were retrospectively analyzed for the influence of traditional risk factors on transplantation outcome. Of 2364 transplants, 67% were from living donors, 27% were from donors who met standard criteria, and 6% were from donor who met expanded criteria. Two hundred thirty-nine procedures (10%) were performed in pediatric patients. Immunosuppression was selected on the basis of subgroup population.


RESULTS
At 1 year posttransplantation, cumulative freedom from a treated acute rejection episode (ARE) was 76.7%, with no difference between black vs nonblack recipients (75.0% vs 73.4%; P = .79). At 2 years, survival for patients (95.3% vs 88.3% vs 82.1%; P < .001) and grafts 92.3% vs 80.3% vs 70.9%; P < .001) was better in recipients of living donor grafts compared with donors who met standard or expanded criteria, respectively. Moreover, graft survival was poorer in black vs nonblack patients (83.6% vs 88.7%; P < .05) because of high mortality (13% vs 7%; P<.001). Risk factors associated with death included cadaveric donor organ (odds ratio [OR], 2.4) and black race (OR, 1.8), and risk factors associated with graft loss included cadaveric donor organ (OR, 2.1), extended-criteria criteria donor organ (OR, 2.0), delayed graft function (OR, 1.8), and any ARE (OR, 3.5). At 6 months posttransplantation, risk factors associated with death included cadaveric donor organ (OR, 2.5) or ARE (OR, 2.4), and risk factors associated with graft loss included cadaveric donor organ (OR, 2.0), extended-criteria donor organ (OR, 2.6), ARE (OR, 9.5), and impaired graft function (creatinine concentration >1.5 mg/dL; OR, 2.1).


CONCLUSIONS
Traditional risk factors are still associated with transplantation outcome. Poorer graft survival in black vs nonblack recipients was due to higher mortality rather than graft loss.
Harada
K M
KM
Division of Nephrology, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil. kelly.harada@medfarm.com.br
Mandia-Sampaio
E L
EL
de Sandes-Freitas
T V
TV
Felipe
C R
CR
Park
S I
SI
Pinheiro-Machado
P G
PG
Garcia
R
R
Tedesco-Silva
H
H
Medina-Pestana
J O
JO
D000328:Adult; D015992:Body Mass Index; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D018579:Patient Selection; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D017211:Treatment Failure