Analysis of 1,500 Kidney Transplantations at Sungkyunkwan University

Jae Woong Hong; Milljae Shin; Hyung Hwan Moon; Sanghoon Lee; Jong Man Kim; Jae Berm Park; Choon Hyuck David Kwon; Jae-Won Joh; Suk-Koo Lee; Sung-Joo Kim

doi:10.4285/jkstn.2014.28.1.25

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Hong, Shin, Moon, Lee, Kim, Park, Kwon, Joh, Lee, and Kim: Analysis of 1,500 Kidney Transplantations at Sungkyunkwan University

Original Article

J Korean Soc Transplant 2014;28(1):25-35.

Published online: 10 March 2014

DOI: https://doi.org/10.4285/jkstn.2014.28.1.25

Analysis of 1,500 Kidney Transplantations at Sungkyunkwan University

Jae Woong Hong, M.D., Milljae Shin, M.D., Hyung Hwan Moon, M.D., Sanghoon Lee, M.D., Jong Man Kim, M.D., Jae Berm Park, M.D., Choon Hyuck David Kwon, M.D., Jae-Won Joh, M.D., Suk-Koo Lee, M.D., Sung-Joo Kim, M.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

책임저자：김성주, 서울시 강남구 일원로 81성균관대학교 의과대학 삼성서울병원 외과학교실, 135-710 Tel: 02-3410-3476, Fax: 02-3410-0040 E-mail: kmhyj111@gmail.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The most effective treatment for end-stage renal disease is kidney transplantation, and the number of kidney transplantations has shown a rapid increase. The aim of this study was to determine graft survival and functional outcome of 1,500 kidney transplant cases in a single center. We also investigated the factors affecting graft failure after kidney transplantation.

Methods

We retrospectively reviewed the clinical data of 1,500 pairs of donors and subsequent recipients who underwent kidney transplantation in Samsung Medical Center, from February 1995 to January 2012.

Results

The mean follow-up period was 2,241.5±1,609.4 days. There were 851 (56.7%) male recipients; 62 (4.1%) recipients were younger than 19 years old. Eleven (0.7%) cases were ABO blood group incompatible kidney transplant. A total of 531 (35%) deceased and 969 (65%) living donors were included. Among them, 191 (12.7%) recipients were experienced in graft failure. The most common cause of graft loss was chronic allograft nephropathy. One-year, 5-year, 10-year, and 15-year graft survival were 97.3%, 92.8%, 81.6%, and 75.1% (85.2% for living, 75.4% for deceased donor), respectively. Higher incidence of graft failure was observed in recipients who received deceased donor kidneys or experienced a rejection episode.

Conclusions

In our experience, overall 10-year graft survival after kidney transplantation was 81.6%. This report demonstrated that the type of donor (living or deceased) and history of allograft rejection are the only significant factors affecting graft survival.

Keywords: Kidney transplantation, Living donors, Deceased donor, Graft survival

References

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Fig. 1.

Number of kidney transplantation according to donor types from 1995 to 2012.

Fig. 2.

Distribution of age (A) and gender (B) in recipients and donors.

Fig. 3.

Relationship of donors and recipients. (A) Donor type. (B) Relationship of donor and recipients in living related kidney transplantation. (C) Relationship of donor and recipients in living unrelated kidney transplantation. (D) Donor criteria in deceased donor.

Fig. 4.

Newly developed malignancies after kidney transplantation.

Fig. 5.

Long-term outcomes after kidney transplantation: graft survival. (A) Overall graft survival. (B) Living donor kidney transplantation (LDKT): deceased donor kidney transplantation (DDKT) graft survival.

Fig. 6.

Causes of graft failure after kidney transplantation.

Fig. 7.

Long-term outcomes after kidney transplantation: patient survival. (A) Overall patient survival. (B) Living donor kidney transplantation (LDKT): deceased donor kidney transplantation (DDKT) patient survival.

Table 1.

Baseline demographics of kidney transplantation

Characteristic	No. of patients (%)(n=1,500)	Living donor			Deceased donor	P value
Characteristic	No. of patients (%)(n=1,500)	Related	Unrelated	Living	Deceased donor	P value
Sex (male/female)
Recipient	851/649	347/293	205/124	552/417	299/232	0.830
	(56.7/43.3)
Donor	883/617	365/275	149/180	514/455	369/162	0.000
	(58.9/41.1)
Age (yr), mean±SD (range)
Recipient	40.36±12.11	39.28±12.49	43.38±9.44	40.67±11.71	39.79±12.80	0.180
	(2∼74)
Donor	38.74±12.89	38.18±12.49	43.88±9.44	39.67±10.90	37.03±15.77	0.001
	(1∼75)
Type of donor (living/deceased)	969/531	–	–	–	–	–
Etiology
Glomerulonephritis/nephropathy	200 (13.3)	–	–	–	–	–
Hypertension	221 (14.7)	–	–	–	–	–
Diabetes mellitus	186 (12.4)	–	–	–	–	–
IgA nephropathy	159 (10.6)	–				–
Polycystic kidney disease	42 (2.8)	–				–
Etc.	692 (46.1)	–				–
Pretransplant renal replacement
Hemodialysis	1,046	–	–	–	–	–
Peritoneal dialysis	185	–	–	–	–	–
Pre-emptive	138	–	–	–	–	–
Others	121	–	–	–	–	–
HLA matching		3.42±1.30	1.94±1.02	2.91±1.40	1.89±1.39	0.000
0	114 (7.6)
1	267 (17.8)
2	336 (22.4)
3	473 (31.5)
4	161 (10.7)
5	70 (4.7)
6	79 (5.3)
PRA positive (above class 30%) (+)/(−)	82/116	32/48	18/32	50/80	32/36	0.288
	(41.4/58.6)

Abbreviations: HLA, human leukocyte antigen; PRA, panel reactive antibody.

Table 2.

Use of immunosuppressive agents

Immunosuppressive agent	No.
Induction agent
Anti-thymocyte globulin	218
Anti-CD3 antibody	10
Anti-IL2 receptor antibody	488
Anti-CD52 antibody	9
Maintain agent
Calcineurin inhibitor
Cyclosporin	993
Tacrolimus	484
Azathioprine	183
Mycophenolate mofetil	797
Mycophenolic acid	94
mTOR inhibitor	9

Abbreviation: mTOR, mammalian target of rapamycin.

Table 3.

Immediate and late complications after kidney transplantation

Complication	No.
Immediate operation related complications
Lymphocele	74
Postoperative bleeding	20
Urinary leakage	26
Urinary stricture	9
Renal artery stenosis/thrombosis	3
Wound dehiscence	13
Late metabolic complications
Dyslipidemia	543
Posttransplant diabetes mellitus	131
Avascular necrosis of femoral head	60
Osteoporosis	98

Table 4.

Infectious complications after kidney transplantation

Types of infection	No.
Virus
Cytomegalovirus	624
Parvovirus	175
Polyomavirus	365
Bacteria
Urinary tract infection	203
Pneumonia	111
Sinusitis	21
Others
Fungus	28
Others
Tuberculosis	28
Pneumocystis jiroveci	14

Table 5.

Causes of patient death after kidney transplantation

Cause of death	No. (%)
Bleeding	2 (3.5)
Cardio & cerebrovascular	5 (8.7)
Malignancy	9 (15.7)
Infection	21 (36.8)
Liver failure	3 (5.2)
Trauma	3 (5.2)
Unknown	6 (10.5)
Others (including suicide)	7 (12.2)

Table 6.

Impact factors affecting graft failure after kidney transplantation

Variable	P value
Univariate analysis
Ischemic time (cold/warm)	0.081/0.555
Male gender	0.090
Donor age	0.052
Recipient age	0.947
Recipient body mass index	0.067
Medical comorbidity (hypertension/diabetes)	0.396/0.219
Recipient with hepatitis virus (HBV/HCV)	0.529/0.063
Duration of the pretransplant dialysis	0.068
Pretransplant estimated glomerular filtration rate	0.072
Deceased donor kidney	0.004
Extended criteria donor kidney	0.773
Number of HLA mismatch	0.089
Anti-thymocyte immunoglobulin at perfusion	0.080
Maintenance immunosuppression
Tacrolimus	0.152
Cyclosporin	0.053
Sirolimus	0.139
Without mycophenolate mofetil	0.080
Steroid withdrawal	0.653
History of allograft rejection during follow-up period	0.005
Delayed graft function	0.058
Multivariate analysis
Type of donor (living vs deceased)	0.002
Rejection (positive vs negative)	0.003

Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HLA, human leukocyte antigen.

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