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With the new immunosuppressants introduced in the 1990s, Mycophenolate, Mofetil and Tacrolimus, graft and patient survival rate have greatly improved. Likewise, the literature mentions better results with living donors than with cadaveric donation. The introduction of induction drugs such as baxiliximab, and recently Thymoglobulin, have also improved these survival rates in cadaveric bodies, decreasing the rates of both cellular and humoral acute rejections. The primary objective of this study is to determine the survival rate of kidney grafts from the Renal Transplant Unit of the Social Security Nephrology Service, in addition to certain clinical and epidemiological characteristics of the population studied.
Outcomes. Determine the survival rate of kidney grafts performed in the Renal Transplant Unit HCIPS Nephrology Service from 1986 to 2021. Determine the Clinical and Epidemiological Characteristics of this group of patients.
Observational, Descriptive, Retrospective Cross-sectional Study, with analytical component. Non-probabilistic sample, consecutive cases. Enrollment from the registry of the Renal Transplant Unit HCIPS Nephrology Service of adult kidney transplant patients, from January 1986 to January 2021. Inclusion Criteria: over 18 years of age, living donor kidney transplants and cadaveric donors with regular follow-up by the Transplant Unit. Quantitative Variables: Age (years), creatinine at discharge, graft survival rate. Qualitative Variables: etiology of chronic kidney disease, types of donors, immunosuppressant regimen, complications related to transplant, type of acute rejection, death.
N 172 patients, male 105/172 (61%) female 67/172 (39%). Age 49 years (SD ± 13.4). Cadaveric donor 102 cases (59%) and living donor 70 cases (41%), unknown etiology 86 (50%), Autoimmune 20 (11%), PKR 16 (9) % DM 12 (7%) others 38 (23% ), the average creatinine at discharge 1.26 mg/dl. (SD ± 0.85), Induction was done in 87 cases; basiliximab 86/172 (50%), Thymoglobulin 1 (began to be used in 2019), 85 cases without induction, Immunosuppression; Mycophenolate Mofetil, Tacrolimus 143/172 (83%), Azathioprine was used until 2011 and Cyclosporine until 2014 in certain cases. Rejections 39 cases Cellular 12 (30%) and humoral 27 (70%). Deaths 29 cases (18/29 (62%) with functioning graft), causes of infectious deaths 15/29 (52%) most due to SARS COV 2, cardiovascular 11/29 (38%) and neoplasia 3/29 (10%). There were 10 cases of deaths due to SARS COV 2, which represents 66.6% of the infectious causes of death. Complications related to kidney transplant: N 144, infectious 84 (58.3%), neoplastic 19 (13.19%), cardiovascular 16 (11.11%), metabolic (NODAT) 12 (8.33%), surgical 6 (4.16%), dermatological 4 (2.7%), recurrent GN 2 (1.38%), osteonecrosis of the femoral head 1 (0.69%), there were acute rejections in 39 cases; Cellular 12 (30%) and Humoral 27 (70%). The survival rate of the kidney graft in a Kaplan Meier curve was: 97% at one year, 81% at 5 years and 49% at 10 years, in grafts with a cadaveric donor it was: at one year 96%, at 5 years 70% and at 10 years 23% and with a living donor; at one year 100%, at 5 years 97% at 10 years 90%. Comparing, the survival rate of the kidney graft with a living donor had a better survival rate in general, from one year to 5 years already with a p 0.25 but still not significant, but especially at 10 years with a very significant p 0.04. The probable causes of graft loss were chronic graft dysfunction in most cases, acute humoral and cellular rejections that were diagnosed and treated in 32 cases, and venous thrombosis in 2 cases.
The survival rate of the kidney graft in a Kaplan Meier curve was: 97% at one year, 81% at 5 years and 49% at 10 years, the survival rate of grafts with living donors was better, especially at 5 and 10 years. The patients were mostly male 105/172 (61%), the mean age was 49 years (SD ± 13.4). Induction was done in 87 cases, the majority with Baxiliximab, 85 without induction and the most used immunosuppression was Mycophenolate Mofetil and Tacrolimus 143/172 (83%). There were 39 cases of acute rejection; Cellular 12 (30%) and Humoral 27 (70%) and) the average creatinine at discharge 1.26 mg/dl. (SD ± 0.85. The most frequent complications were infectious 84 (58.3%), neoplastic 19 (13.19%), cardiovascular 16 (11.11%) and metabolic (NODAT) 12 (8.33%). There were 29 deaths, (18/29 (62%) with a functioning graft and the causes of death were infectious 15/29 (52%), the majority due to SARS COV 2, cardiovascular 11/29 (38%) and neoplasias 3 /29 (10%)