Patient Survival in Renal Allograft Failure: A Time-dependent Analysis.
BACKGROUND
To improve patient survival after a renal transplant, it is important to detect which variables affect it.


OBJECTIVE
This study aimed to assess the effect of renal allograft failure on patient survival.


METHODS
This retrospective cohort study included 405 renal transplant patients from Kerman University of Medical Sciences hospital, Kerman, Iran from 2004 to 2010. Kaplan-Meier method was used to estimate survival rates of patients, and time-dependent Cox regression was used to examine the effect of allograft failure on patient survival.


RESULTS
During 4.06 years (median) of follow-up 28 (6.9%) patients died and 20 (71.4%) of dead patients had allograft failure. Survival rate of patients with allograft failure at 1-, 3-, 5-, and 7-year were 0.98, 0.8, 0.53, and 0.53, respectively; in patients with allograft function these values were 0.99, 0.98, 0.97, and 0.96, respectively. The unadjusted death rate was 0.5 per 100 patient years for the maintained allograft function, which increased to 9 per 100 patient years for patients following allograft failure. In fully adjusted model the risk of death increased in patients with allograft failure (HR = 2.09; 95% CI: 1.56-2.81), pretransplant diabetes (HR = 2.81; 95% CI: 1.2-6.7), patients with BMI ≥ 25 (vs. 18.5 ≤ BMI < 25) (HR = 3.56; 95% CI: 1.09-11.6). With an increase in recipient age this risk increased (HR = 1.04 per year increase; 95% CI: 1.01-6.7). Receiving a living kidney transplant decreased this risk (HR = 0.52; 95% CI: 0.39-0.69).


CONCLUSIONS
An increase in recipient age and BMI, affliction with diabetes, allograft failure, and receiving deceased kidney transplant increased the risk of death.
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran.
Moghaddameh
M
Mirzaee
Physiology Research Center, Departments of Nephrology, Urology and Renal Transplantation, Kerman University of Medical Sciences, Kerman, IR Iran ; Departments of Nephrology, Urology and Renal Transplantation, Kerman University of Medical Sciences, Kerman, IR Iran.
Jalal
J
Azmandian
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran.
Hojjat
H
Zeraati
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran.
Mahmood
M
Mahmoodi
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran.
Kazem
K
Mohammad
Department of Urology, Zahedan University of Medical Sciences, Zahedan, IR Iran.
Faramarz
F
Fazeli
Physiology Research Center, Departments of Nephrology, Urology and Renal Transplantation, Kerman University of Medical Sciences, Kerman, IR Iran.
Mohammad-Reza
MR
Ebadzadeh
Kidney Transplantation; Survival; Transplantation, Homologous