J Korean Soc Transplant.  2017 Dec;31(4):182-192. 10.4285/jkstn.2017.31.4.182.

Clinical Outcomes and Contributors in Contemporary Kidney Transplantation: Single Center Experience

Affiliations
  • 1Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. jslee@uuh.ulsan.kr
  • 2Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 3Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Abstract

BACKGROUND
In recent years, introduction of novel immunosuppressive agents and its proper implementation for clinical practice have contributed to improving clinical outcomes of kidney transplantation (KT). Here, we report clinical outcomes of KTs and related risk factors.
METHODS
From July 1998 to June 2016, 354 KTs (182 from living and 172 from deceased donors) have been performed at Ulsan University Hospital. We retrospectively reviewed the clinical characteristics and outcomes of KT recipients, then estimated graft and patient survival rate were estimated and analyzed risk factors using Cox-regression.
RESULTS
The median follow-up period was 53 months (range; 3 to 220 months). The mean ages of recipients and donors were 45.0 years (SD, 12.5) and 44.7 years (SD, 13.6) years, respectively. During follow-up, 18 grafts were lost and 5- and 10-year death-censored graft survival was 96.7% and 91.5%, respectively. Biopsy-proven acute rejection (BPAR) occurred in 71 patients (55 cases of acute cellular rejection and 16 of antibody-mediated rejection). Cox-regression analysis showed that BPAR was a risk factor related to graft loss (hazard ratio [HR], 14.38; 95% confidence interval [CI], 3.79 to 54.53; P < 0.001). In addition, 15 patients died, and the 5- and 10-year patient survival was 97.2% and 91.9%, respectively. Age ≥60 years (HR, 6.03; 95% CI, 1.12 to 32.61; P=0.037) and diabetes (HR, 6.18; 95% CI, 1.35 to 28.22; P=0.019) were significantly related to patient survival.
CONCLUSIONS
We experienced excellent clinical outcomes of KT in terms of graft failure and patient survival despite the relatively high proportion of deceased donors. Long-term and short-term clinical outcomes have improved in the last two decades.

Keyword

Long-term outcomes; Kidney transplantation; Acute rejection

MeSH Terms

Follow-Up Studies
Graft Survival
Humans
Immunosuppressive Agents
Kidney Transplantation*
Kidney*
Retrospective Studies
Risk Factors
Survival Rate
Tissue Donors
Transplants
Ulsan
Immunosuppressive Agents

Figure

  • Fig. 1 Graft survival rates of all kidney transplantation (A) and by donor types. (B) Living donor vs. deceased donor.

  • Fig. 2 Patient survival rates of all kidney transplantation (A) and by donor types. (B) Living donor vs. deceased donor.

  • Fig. 3 Graft survival rates of deceased donor kidney transplantation by donor types. Standard criteria donor vs. expanded criteria donor.

  • Fig. 4 Graft survival rates by median time of cold ischemic time (CIT).

  • Fig. 5 Graft survival rates by existence of acute rejection (A) and by type of acute rejection. (B) Acute T-cell mediated rejection (ATR) vs. acute antibody-mediated rejection (AMR).


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