title: Thirty Years of Experience at the First Tunisian Kidney Transplant Center.
abstract: OBJECTIVE
  The aim of this study was to report the results of 30 years of experience at the first kidney transplant center in Tunisia.
  
  
  METHODS
  All kidney transplants performed at the center between June 1986 and June 2016 were included. The study period was divided into 3 decades. Recipient and donor data and follow-up information were obtained from a local database and patient medical records. Comparative analyses were performed using the t test for continuous variables and the Χ² test for qualitative variables. Patient and graft survival rates were calculated according to the actuarial method, and comparison of survival curves was performed according to the logrank test.
  
  
  RESULTS
  The mean age of recipients was 32.7 ± 11.5 years (range, 6-65 y) with a gender ratio of 2.2. Duration of prekidney transplant dialysis varied from 2 months to 20 years (median, 27.5 mo); 1.7% of patients underwent transplant preemptively. Kidneys were recovered from deceased donors in 21.2% of cases and from living donors in 78.8%. The proportion of deceased donors dropped from 27.4% during the period 2006-2010 to 12.9% during the period 2011-2015 (P < .04). Patient survival rates at 1, 5, 10, 15, and 20 years were 96%, 89.3%, 79.5%, 71.1%, and 65.4%. Graft survival rates were 95%, 86.5%, 76.2%, 66.3%, and 57.2%. The annual graft loss was 2.9%, with a mortality rate of 2.4% and without significant differences between patients receiving deceased-donor and living-donor organs.
  
  
  CONCLUSIONS
  Kidney transplant activity remains suboptimal in our country. The reduction in deceased-donor organs could be related to the political transformations facing our country with their resulting social and economic consequences. Efforts should be made to increase governmental resources and to improve both public awareness of organ donation and the motivation of transplant teams.
authors.affiliation: Department of Nephrology and Internal Medicine, University Tunis El Manar, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Ezzedine
authors.initials: E
authors.lastname: Abderrahim
authors.forename: Asma
authors.initials: A
authors.lastname: Zammouri
authors.forename: Mohamed Mongi
authors.initials: MM
authors.lastname: Bacha
authors.forename: Mondher
authors.initials: M
authors.lastname: Ounissi
authors.forename: Tahar
authors.initials: T
authors.lastname: Gargah
authors.forename: Hafedh
authors.initials: H
authors.lastname: Hedri
authors.forename: Riadh
authors.initials: R
authors.lastname: Ben Slama
authors.forename: Rafika
authors.initials: R
authors.lastname: Bardi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Chebil
authors.forename: Taieb
authors.initials: T
authors.lastname: Ben Abdallah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D006435:Renal Dialysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014416:Tunisia; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents