First 1500 Kidney Transplants at the Institute of Nephrology and Urology in Uruguay: Analysis of the Results.
BACKGROUND
The Institute of Nephrology and Urology (INU) has performed 75% of kidney transplantations (KT) in Uruguay during its 35 years of activity, with 90.6% from cadaveric donors. We investigated the risk factors (RF) for delayed graft function (DGF) and patient and graft survival (SV).


METHODS
We analyzed retrospectively the characteristics and evolution of 1500 KT performed by INU until December 2014. The incidence of DGF and RF for patient and graft SV were analyzed in 4 eras, according to the year that KT was performed.


RESULTS
The number of KT per year has progressively increased until reaching 40 KT per million population in 2006, with a decrease of the living donor KT (LDKT) rate. The age of the donors (D) and recipients (R) as well as the time on dialysis (TOD) have progressively increased over the different eras. Five hundred twenty-five R (35%) presented with DGF. The RF for DGF were the age of the R and the D, the TOD, the DDKT, and the warm ischemia time (WIT). In the DDKT group, the cold ischemia time and "died of stroke" were added factors. The death-censored graft SV at 1, 5, 10, and 15 years were 90%, 76%, 62%, and 49%, respectively. They improved as from era I, the patient SV being 92%, 83%, and 75% at 1, 5, and 10 years, in era I; 98%, 93%, and 86% in era II; 98%, 92%, and 83% in era III; and 95% and 90% at 1 and 5 years in era IV (P < .001). The graft SV over the same periods was 76%, 58%, and 40% in era I; 88%, 68%, and 52% in era II; 93%, 81%, and 70% in era III; and 93% and 85% at 1 and 5 years in era IV (P < .0001). The RF for patient SV were diabetes mellitus, era I, lower albuminemia, older age or TOD, and DGF. For kidney SV, the era, the age of the R, TOD, DGF, and D older than 60 years were RF associated with a worse evolution. In DDKT, the RF for the graft SV were the era, younger age of the R, and DGF. The group with the worst graft SV was the one made up of children and adolescents.


CONCLUSIONS
Our results relating to patient and graft SV are acceptable and comparable to those mentioned on large records such as the OPNT/SRTR and the Collaborative Transplant Study. This has been the case, even though we have transplanted increasingly aged patients, with increasingly aged donors, or donors with associated pathology. The risk factors that we found both for DGF and SV have also been pointed out by other authors. The validity of some findings has the limitation of being from a retrospective analysis; hence, they should be corroborated by a prospective study.
Nephrology and Urology Institute, Montevideo, Uruguay. Electronic address: serori2014@gmail.com.
S
S
Orihuela
Nephrology and Urology Institute, Montevideo, Uruguay.
L
L
Curi
Nephrology and Urology Institute, Montevideo, Uruguay.
M
M
Nin
Nephrology and Urology Institute, Montevideo, Uruguay.
L
L
Manzo
Nephrology and Urology Institute, Montevideo, Uruguay.
G
G
Gonzalez
Nephrology and Urology Institute, Montevideo, Uruguay.
N
N
Nuñez
Nephrology and Urology Institute, Montevideo, Uruguay.
M
M
Kurdian
Nephrology and Urology Institute, Montevideo, Uruguay.
L
L
Cuñeti
Nephrology and Urology Institute, Montevideo, Uruguay.
P
P
Larre Borges
Nephrology and Urology Institute, Montevideo, Uruguay.
F
F
González-Martínez
D000047:Academies and Institutes / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002102:Cadaver; D002648:Child; D051799:Delayed Graft Function / Q000401:mortality; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014572:Urology / Q000706:statistics & numerical data; D014583:Uruguay / Q000453:epidemiology; D055815:Young Adult