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

Jae-Sung Ahn; Kyung Sun Park; Jongha Park; Hyun Chul Chung; Hojong Park; Sang Jun Park; Hong Rae Cho; Jong Soo Lee

doi:10.4285/jkstn.2017.31.4.182

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Ahn, Park, Park, Chung, Park, Park, Cho, and Lee: Clinical Outcomes and Contributors in Contemporary Kidney Transplantation: Single Center Experience

Original Article

The Journal of the Korean Society for Transplantation 2017; 31(4): 182-192.

Published online: 31 December 2017

DOI: https://doi.org/10.4285/jkstn.2017.31.4.182

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

Jae-Sung Ahn, M.D.¹, Kyung Sun Park, M.D.^1,², Jongha Park, M.D.^1,², Hyun Chul Chung, M.D.^1,², Hojong Park, M.D.³, Sang Jun Park, M.D.^2,³, Hong Rae Cho, M.D.^2,³, Jong Soo Lee, M.D.^1,²

¹Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

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.

Corresponding author: Jong Soo Lee. Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 44033, Korea. Tel: 82-52-250-8843, Fax: 82-52-250-7048, jslee@uuh.ulsan.kr

Received 30 August 2017 Revised 22 October 2017 Accepted 23 October 2017

Rhe Korean Society for Transplantation

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.

Keywords: Long-term outcomes, Kidney transplantation, Acute rejection

Figures and Tables

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).

Table 1

Baseline characteristics of kidney transplantation recipients

Data are presented as mean±SD or number (%).

Abbreviations: ESRD, end-stage renal disease; DM, diabetes mellitus; HTN, hypertension; CGN, chronic glomerulonephritis; KT, kidney transplantation; RRT, renal replacement therapy; HLA, human leukocyte antigen; PRA, panel reactive antigen; CMV, cytomegalovirus; IgG, immunoglobulin G; IS, immunosuppressant; CNI, calcineurin inhibitor.

Table 2

Baseline characteristics of kidney donors

Data are presented as mean±SD or number (%).

Table 3

Clinical outcomes of kidney transplantation recipients

Data are presented as median (range), number (%), or mean±SD.

Abbreviations: CIT, cold ischemic time; eGFR, estimated glomerular filtration rate; BPAR, biopsy-proven acute rejection; CMV, cytomegalovirus; PJP, Pneumocystis jrioveci pneumonia; GN, glomerulonephritis; NODAT, new onset diabetes after transplantation.

Table 4

Detailed causes of graft failure and patient death (n=354)

Table 5

Detailed causes of expanded criteria donor (n=45)

Table 6

Factors associated with graft failure

Abbreviations: HR, hazard ratio; CI, confidenca interval; HLA, human leukocyte antigen; IS, immunosuppressant; IL-2RA, interleukin 2 receptor alpha; ATG, anti-thymocyte globulin; CNI, calcineurin inhibitor; BPAR, biopsy-proven acute rejection; AMR, antibody-mediated rejection; ATR, acute T-cell mediated rejection; CMV, cytomegalovirus; eGFR, estimated glomerular filtration rate.

Table 7

Factor associated with patient death

Abbreviations: HR, hazard ratio; CI, confidenca interval; HLA, human leukocyte antigen; IS, immunosuppressant; IL-2RA, interleukin 2 receptor alpha; ATG, anti-thymocyte globulin; BPAR, biopsy-proven acute rejection; CMV, cytomegalovirus; eGFR, estimated glomerular filtration rate.

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