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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
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Medicina 2017, 53(4), 224-232; https://doi.org/10.1016/j.medici.2017.07.003 (registering DOI)

Factors influencing renal graft survival: 7-Year experience of a single center

1
Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
2
Department of Urology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
3
Department of Nephrology, Republican Hospital of Panevėžys, Panevėžys, Lithuania
4
Institute of Physiology and Pharmacology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
*
Author to whom correspondence should be addressed.
Received: 6 December 2016 / Revised: 29 June 2017 / Accepted: 17 July 2017 / Published: 29 July 2017
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Abstract

Background and objective: The demand for kidney transplants exceeds the existing supply. This leads to a recently growing interest of research in the area of factors that could prolong graft long-term outcomes and survival. In Lithuania, approximately 90% of kidney transplantations are from deceased donors. Donor organs are received and shared only inside the country territory in Lithuania; therefore, donor data is accurate and precise. This study was performed to present particularities of kidney transplantation data in Lithuania and to identify the effect of donor and recipient factors and histologic findings on renal graft outcomes. The aim of this study was to identify the effect of donor and recipient factors and histologic findings on renal graft outcomes.
Materials and methods: We analyzed the influence of deceased donor and recipient factors and histological findings on the graft function in 186 renal transplant patients. Graft survival was estimated within the first year after transplantation.
Results: The donors and recipients were older in worse eGFR group 1 year after transplantation. Dissimilarity of degree of glomerulosclerosis (GS), interstitial fibrosis (IF) and arteriolar hyalinosis (AH) were significant in inferior and superior renal function groups (GS >20% 11.4 vs. 0%, P = 0.017; IF 9.3 vs. 0%, P = 0.034; AH 69 vs. 26.2%, P < 0.001). Nine independent variables were significantly associated with a worse renal transplant function 1 year posttransplantation: AH (OR = 6.287, P < 0.001), an episode of urinary tract infection (OR = 2.769, P = 0.020), acute graft rejection (OR = 3.605, P = 0.037), expanded criteria (OR = 4.987, P = 0.001), female gender donors (OR = 3.00, P = 0.014), cerebrovascular disease caused donor brain death (OR = 5.00, P = 0.001), donor's age (OR = 1.07, P < 0.001), and recipient's age (OR = 1.047, P = 0.022). Worse renal graft survival 1 year posttransplantation was associated with a delayed graft function and a higher level of glomerulosclerosis in time-zero biopsy.
Conclusions: Donor factors, such as age, female gender, brain death of cerebrovascular cause and expanded criteria donor status had a significant negative impact on the renal graft function 1 year after transplantation. Recipients' age, urinary tract infection and acute graft rejection episodes after transplantation were associated with a worse kidney function 1 year after transplantation. Lower 1-year graft survival was related to a delayed graft function (DGF) and a higher degree of glomerulosclerosis.
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Keywords: Kidney transplantation; Graft survival; Time-zero biopsy; Core needle Kidney transplantation; Graft survival; Time-zero biopsy; Core needle
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Auglienė, R.; Dalinkevičienė, E.; Kuzminskis, V.; Jievaltas, M.; Peleckaitė, L.; Gryguc, A.; Stankevičius, E.; Bumblytė, I.A. Factors influencing renal graft survival: 7-Year experience of a single center. Medicina 2017, 53, 224-232.

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