title: Risk Factors Affecting Graft and Patient Survivals After Transplantation From Deceased Donors in a Developing Country: A Single-Center Experience.
abstract: OBJECTIVE
  The aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors.
  
  
  METHODS
  We retrospectively analyzed the outcomes of 186 transplantations from deceased donors performed at our center between 2006 and 2014. The recipients were divided into two groups: Group I (141 recipients without graft loss) and Group II (45 recipients with graft loss). Kaplan-Meier, log-rank test, and Cox proportional hazard regressions were used.
  
  
  RESULTS
  The characteristics of both groups were similar except renal resistive index at the last follow-ups. When graft survival and mortality at the first, third, and fifth years were analyzed, tacrolimus (Tac)-based regimens were superior to cyclosporine (CsA)-based regimens (P < .001). Risk factors associated with graft survival at the first year included cardiac cause of death (versus cerebrovascular accident [CVA]; hazard ratio [HR], 6.36; 95% confidence interval [CI], 1.84-22.05; P = .004), older transplant age (HR, 1.05; 95% CI, 1.02-1.08; P < .001), and high serum creatinine level at 6 months post-transplantation (HR, 1.74; 95% CI, 1.48-2.03; P < .001), whereas younger donor age decreased risk (HR, 0.97; 95% CI, 0.95-1.00; P = .019). Also, the Tac-based regimen had a 3.63-fold (95% CI, 1.47-8.97; P = .005) lower risk factor than the CsA-based regimen, and 2.93-fold (95% CI, 1.13-7.63; P = .027) than other regimens without calcineurin inhibitors. When graft survival at 3 years was analyzed, diabetes mellitus was lower than idiopathic causes and pyelonephritis (P = .035). In Cox regression analysis at year 3, older transplantation age (HR, 1.20; 95% CI, 1.04-1.39; P = .014) and serum creatinine level at month 6 post-transplantation (HR, 1.65; 95% CI, 1.42-1.90; P < .001) were significant risk factors for graft survival. Hemodialysis (HD) plus peritoneal dialysis (PD) treatment was 2.22-fold (95% CI, 1.08-4.58; P = .03) risk factor than only HD before transplantation. When graft survival and mortality at year 5 were analyzed, diabetes mellitus was lower compared with all other diseases. In Cox regression analysis at year 5, younger donor age (HR, 0.73; 95% CI, 0.62-0.86; P < .001) was protective for graft survival, whereas older transplantation age (HR, 1.40; 95% CI, 1.20-1.64; P < .001) and serum creatinine level at month 6 of post-transplantation (HR, 1.39; 95% CI, 1.19-1.61; P < .001) were significant risk factors. PD increased 3.32 (95% CI, 1.28-8.61; P = .014) times the risk than HD. In Cox regression analysis at year 1, cardiac cause of death (versus CVA; HR, 5.28; 95% CI, 1.37-20.31; P = .016), CsA-based regimen (versus Tac; HR, 4.95; 95% CI, 1.78-13.78; P = .002), HD plus PD treatment (versus alone HD; HR, 3.26; 95% CI, 1.28-8.30; P = .013), older transplantation age (HR, 1.08; 95% CI, 1.04-1.11; P < .001), serum creatinine level at month 6 post-transplantation (HR, 1.34; 95% CI, 1.11-1.62; P = .003), and low HLA mismatches (HR, 1.67; 95% CI 1.01-2.70; P = .044) were risk factors for mortality. At year 3, CsA-based regimen (versus Tac; HR, 3.54; 95% CI, 1.32-9.47; P = .012), PD (versus HD; HR, 5.04; 95% CI, 1.41-18.05; P = .013), HD plus PD treatment (versus alone HD; HR, 3.51; 95% CI, 1.37-9.04; P = .009), and older transplantation age (HR, 1.27; 95% CI 1.05-1.53; P = .015) were risk factors for mortality. At year 5, older age at transplantation (HR, 1.47; 95% CI, 1.23-1.77; P < .001), PD (versus HD; HR, 9.21; 95% CI, 3.09-27.45; P < .001), and CsA-based regimen (versus Tac; HR, 2.75; 95% CI, 1.04-7.23; P = .041) were risk factors for mortality, whereas younger donor age decreased risk (HR, 0.71; 95% CI, 0.56-0.86; P < .001).
  
  
  CONCLUSIONS
  Death of donor with cardiac cause, CsA-based immunosuppressive regimen, donor age, serum creatinine level at month 6 post-transplantation, and renal replacement therapy before transplantation affected mortality and graft survival in deceased donors.
authors.affiliation: Department of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey. Electronic address: yavuzayar@hotmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Ayar
authors.affiliation: Department of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Ersoy
authors.affiliation: Department of Biostatistics, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Ocakoglu
authors.affiliation: Department of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Yildiz
authors.affiliation: Department of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Oruc
authors.affiliation: Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Soyak
authors.affiliation: Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Calapkulu
authors.affiliation: Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: A B
authors.initials: AB
authors.lastname: Sahin
authors.affiliation: Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: N Bolca
authors.initials: NB
authors.lastname: Topal
authors.affiliation: Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Okeer
authors.affiliation: Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Coskun
authors.affiliation: Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Kaygisiz
authors.affiliation: Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Kordan
authors.affiliation: Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Vuruskan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003906:Developing Countries; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000601:surgery; D017582:Renal Replacement Therapy / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors / Q000706:statistics & numerical data; D066027:Transplant Recipients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus