title: Low-Activity Kidney Transplant Center, A Single-Center Experience: Early Care as a Major Challenge.
abstract: In many countries, some kidney transplants are performed in small centers, from which clinical data are rarely specifically reported. The aim of this study was to describe patient and graft survival rates and their correlates in a low-activity kidney transplant center.
  
  
  
  We performed a retrospective cohort study of all patients who underwent transplant between January 2002 and May 2012 at a university hospital. Patient, graft, and death-censored graft survival rates were assessed with Kaplan-Meier analyses and compared by log-rank test, with associated factors analyzed by Cox proportional hazards modeling.
  
  
  
  Among a total of 162 patients, the mean age was 41.8 ± 13.5 years, and 92% received a living-donor graft. At 1, 3, and 5 years, patient survival was 88.6%, 86%, and 82.9%. Graft survival was 86.9%, 83%, and 77%, and death-censored graft survival was 98.1%, 96.6%, and 92.9% at the same time points. Most graft losses were due to patient death from infection and occurred within the first year after transplant. After adjustment, age over 42 years (hazard ratio of 3.94; 95% confidence interval, 1.39-11.13), deceased donor graft (hazard ratio of 11.41; 95% confidence interval, 1.2-108.35), and higher average education (hazard ratio of 4.96; 95% confidence interval, 1.01-24.32) were independently associated with graft loss.
  
  
  
  The observed patient and graft survival rates were similar to those described in large databases; however, early mortality remains a major challenge. Improving posttransplant care is a key issue to increasing survival in small transplant centers.
authors.affiliation: Division of Nephrology, Federal University of Juiz de Fora Hospital, and the Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Luciane Senra de Souza
authors.initials: LS
authors.lastname: Braga
authors.forename: Lucas
authors.initials: L
authors.lastname: Moratelli
authors.forename: Moises
authors.initials: M
authors.lastname: Carminatti
authors.forename: Elisa de Oliveira
authors.initials: EO
authors.lastname: Marsicano
authors.forename: Fernando Antonio Basile
authors.initials: FA
authors.lastname: Colugnati
authors.forename: Helady
authors.initials: H
authors.lastname: Sanders-Pinheiro
mesh_terms: D000328:Adult; D000359:Aftercare; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D007674:Kidney Diseases; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality* / Q000451:nursing; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000451:nursing; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000401:mortality / Q000451:nursing; D015996:Survival Rate