Risk Factors for Graft Failure and Death following Geriatric Renal Transplantation

<div><p>Background</p><p>Population aging is a major health concern in Asian countries and it has affected the age distribution of patients with end-stage renal disease (ESRD). As a consequence, the need for kidney transplantation in the geriatric population has increased, but the shortage of donors is an obstacle for geriatric renal transplantation. The aim of this study was to evaluate risk factors for graft failure and death in geriatric renal transplantation.</p><p>Methods</p><p>Kidney transplantations performed in a tertiary hospital in South Korea from May 1995 to December 2014 were retrospectively reviewed. Recipients younger than 60 years of age or who underwent other organ transplantations were excluded. The Kaplan-Meier method was used to assess patient and graft survival. A Cox regression analysis was used to evaluate risk factors for graft failure and patient death.</p><p>Results</p><p>A total of 229 kidney transplantation patients were included. Graft survival at 1, 5, and 10 years were 93.2%, 82.9%, and 61.2% respectively. Patient survival at 1, 5, and 10 years were 94.6%, 86.9%, and 68.8%, respectively. According to the Cox multivariate analysis, ABO incompatibility (hazard ratio [HR] 3.91, p < 0.002), DGF (HR 3.544, p < 0.004), CMV infection (HR 2.244, p < 0.011), and HBV infection (HR 6.349, p < 0.015) were independent risk factors for graft survival. Recipient age (HR 1.128, p < 0.024), ABO incompatibility (HR 3.014, p < 0.025), CMV infection (HR 2.532, p < 0.010), and the number of HLA mismatches (HR 1.425, p < 0.007) were independent risk factors for patient death.</p><p>Conclusion</p><p>Kidney transplantation in the geriatric population showed good clinical outcomes. ABO incompatibility, DGF, CMV infection, and HBV infection were risk factors for graft failure and the recipient age, ABO incompatibility, CMV infection, and the number of HLA mismatches were risk factors for patient death in geriatric renal transplantation.</p></div

Cause of death in the study population according to the type of donor.

<p>Cause of death in the study population according to the type of donor.</p

Baseline characteristics of the study subjects.

<p>Baseline characteristics of the study subjects.</p

Graft survival rates following kidney transplantation in the Korean geriatric recipients.

<p>Graft survival rates following kidney transplantation in the Korean geriatric recipients.</p

Risk factors for patient death.

<p>Risk factors for patient death.</p

Risk factors for graft failure.

<p>Risk factors for graft failure.</p

Additional file 1: of Risk factors for new-onset diabetes mellitus after living donor kidney transplantation in Korea - a retrospective single center study

Supporting information file. Raw data of study population. (XLSX 185 kb

Posttransplant Hyponatremia Predicts Graft Failure and Mortality in Kidney Transplantation Recipients: A Multicenter Cohort Study in Korea - Fig 2

<p>Kaplan-Meier curves for the cumulative risks of acute rejection (A), graft failure (B), and all-cause mortality (C).</p

Baseline characteristics of the study subjects.

<p>Baseline characteristics of the study subjects.</p

Effect of post-transplant glycemic control on long-term clinical outcomes in kidney transplant recipients with diabetic nephropathy: A multicenter cohort study in Korea

<div><p>Purpose</p><p>Diabetic nephropathy is the leading cause of end stage renal disease. The number of kidney transplantation (KT) due to diabetic nephropathy is increasing and there is debate on glycemic control after KT. In this study, we used a multi-center database to determine the relationship between post-transplant glycemic control and the outcomes of KT in patients with diabetic nephropathy.</p><p>Methods</p><p>We conducted a retrospective chart review of kidney transplant recipients (KTRs) with diabetic nephropathy from three tertiary hospitals to analyze the association between post-transplant glycemic control and the clinical outcomes of graft failure, including patient death and biopsy-proven acute rejection (BPAR). We assessed time-averaged glucose level and hemoglobin A1c (HbA1c) for 36 months after KT.</p><p>Results</p><p>Among 3,538 KTRs, a total of 476 patients received kidney transplantation because of diabetic nephropathy. Mean time-averaged glucose and HbA1c levels were 147 ± 46 mg/dl and 7.7 ± 1.5%, respectively. Patients with diabetic nephropathy had poor graft and patient survival rate compared with non-diabetic nephropathy. Among KTRs with diabetic nephropathy, the highest quartile of time-averaged glucose was related to poor graft outcomes and the 3^rd quartile of time-averaged HbA1c was associated with significantly better graft outcomes than the 1^st, 2^nd or 4^th quartiles. There were no significant differences in the risk of BPAR across the 4 quartiles of glucose and HbA1c.</p><p>Conclusions</p><p>Strict glycemic control before KT might not be related to successful outcomes but poor glycemic control after KT is associated with poor graft outcomes. There was no significant relationship between pre- or post-transplant glycemic control and BPAR.</p></div