PATIENT-GRAFT SURVIVAL ANALYSIS PATIENT-GRAFT SURVIVAL ANALYSIS IN KIDNEY TRASPLANT WITH IN KIDNEY TRASPLANT WITH

DECEASED DONOR IN CHILDREN IN DECEASED DONOR IN CHILDREN IN ARGENTINA 1998-2009ARGENTINA 1998-2009

Bisigniano Liliana MD., López-Rivera Arturo MD., Tagliafichi Viviana, Fernández Víctor J MD., Soratti Carlos A MD.

Introduction

•Thanks to advances in surgical techniques and immune system suppression, the mortality rate in children with chronic renal failure has dramatically declined.

•Kidney transplantation has become the standard of care for ESRD in the pediatric population

Objective

To analyze the variables included in organ procurement, retrieval and transplantation associated to both patient and graft survival in kidney transplant using deceased donors in patients under 18 years of age.

Materials & Methods

• The information was obtained from SINTRA for the period 1998-2009.

• The Kaplan-Meir method was used; survival at 30 days, 1, 5 and 10 yrs. was recorded .

• The Cox regression model was used to consider the variables for both patient and graft survival such as gender and age

The MedCalc and SPSS 17 statistical packages were used

Materials & Methods

Independent Variables

Gender

Donor´s Age

Recipient´s Age

CIT < or > 24 hs

Etiology of ERSD

Time on Dialysis (< or > 7 yrs.)

Cause of Donor´s Death

Mismatch HLA from 0 to 6

Results

Survival

GENDER 345 (54%) FEMALES AND 290 (46%) MALES

AGE 12.5+ 3.9 years

MEAN FOLLOW UP 4 YEARS (MAX 13 YEARS)

PATIENT GRAFT30 days 99.4% 97.2%1 st year 96.8% 91.9%5 years 91.1% 79.3%10 years 82.5% 61.8%

ResultsPatient Survival CurvePatient Survival Curve

30 days 1 year 5 years 10 years

99.40% 96.80% 91.10% 82.50%

ResultsGraft Survival CurveGraft Survival Curve

30 days 1 year 5 years 10 years

97.20% 91.90% 79.30% 61.80%

ResultsCox regression – patient survival

VARIABLE HR IC 95% PDonor`s age 18-44 years 0.67 0.37-1.26 0.227Donor`s age 45-59 years 1.22 0.51-2.92 0.654Donor`s age >60 years - - -Recipient`s age >12 years 2.05 1.13-3.70 0.018CIT > 24 hrs 0.63 0.36-1.11 0.635Obstructive nephropathy 1.26 0.60-2.65 0.539Glomerulonephritis 1.08 0.53-2.20 0.843Unknown 0.69 0.25-1.90 0.474Uremic Hemolytic Syndrome 1.09 0.37-3.23 0.879Renal polycystosis 2.31 0.53-10.08 0.975Interstitial tubulonephritis - - -CVA 1.20 0.61-2.35 0.605Anoxia 0.37 0.05-2.95 0.345Other cause of coma 1.44 0.33-6.34 0.629Tumor 14.99 3.92-57.35 <0.0001CNS infections - - -Time on dialysis >7 years 0.64 0.36-1.11 0.110Female recipient 1.83 1.06-3.16 0.029Female donor 1.89 1.08-3.33 0.026

ResultsCox regression – patient survival

VARIABLE HR IC 95% PDonor`s age 18-44 years 0.67 0.37-1.26 0.227Donor`s age 45-59 years 1.22 0.51-2.92 0.654Donor`s age >60 years - - -Recipient`s age >12 years 2.05 1.13-3.70 0.018CIT > 24 hrs 0.63 0.36-1.11 0.635Obstructive nephropathy 1.26 0.60-2.65 0.539Glomerulonephritis 1.08 0.53-2.20 0.843Unknown 0.69 0.25-1.90 0.474Uremic Hemolytic Syndrome 1.09 0.37-3.23 0.879Renal polycystosis 2.31 0.53-10.08 0.975Interstitial tubulonephritis - - -CVA 1.20 0.61-2.35 0.605Anoxia 0.37 0.05-2.95 0.345Other cause of coma 1.44 0.33-6.34 0.629Tumor 14.99 3.92-57.35 <0.0001CNS infections - - -Time on dialysis >7 years 0.64 0.36-1.11 0.110Female recipient 1.83 1.06-3.16 0.029Female donor 1.89 1.08-3.33 0.026

RESULTS

VARIABLE HR IC 95% PDonor`s age 18-44 years 1.01 0.67-1.50 0.981Donor`s age 45-59 years 2.52 1.42-4.47 0.002Donor`s age >60 years 2.56 0.33-19.99 0.372Recipient`s age >12 years 1.21 0.84.1.73 0.303CIT > 24 hrs 1.59 1.11-2.28 0.012Obstructive nephropathy 1.14 0.68-1.91 0.627Glomerulonephritis 1.71 1.09-2.77 0.012Unknown 0.97 0.51-1.83 0.992Uremic hemolytic syndrome 1.12 0.55-2.31 0.752Renal polycystosis 2.55 1.00-6.51 0.051Interstitial tubulonephritis 1.36 0.32-5.73 0.678CVA 1.34 0.86-2.10 0.197Anoxia 1.36 0.53-3.50 0.530Other cause of coma 4.28 1.27-14.37 0.019Tumor - - 0.967CNS infections - - -Time on dialysis >7 years 1.59 1.11-2.28 0.018Female recipient 1.10 0.78-1.56 0.581Female donor 1.25 0.87-1.80 0.234

Cox regression – graft survival

Conclusions

• Female gender as a donor or recipient, a recipient older than 12 and a tumor as the cause of death were associated with a worse survival rate for recipient.

• The donor´s age between 45 and 59 yrs., the presence of glomerulonephritis as the etiology of renal failure, CIT > 24hrs and time on dialysis >7 yrs. were associated with a lower graft survival rate.

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