Graft survival analysis in kidney transplantation: a 12-year experience in a Thai medical center

To analyze graft survival and to find the factors that influence survival in kidney transplantation recipients, we performed an analytic retrospective study.

A retrospective analysis was undertaken on records of all patients who underwent transplantation from December 25, 1990 to December 24, 2002. Survival studies were calculated using the Kaplan-Meier method. The outcome endpoints were death, redialysis, lost to follow-up, and study termination.

One hundred thirty-eight operations (49 living-related kidney transplantations [LRKT] and 89 cadaveric kidney transplantations [CDKT])were recruited. Age of patients was 39.9 +/- 9.8 years (range, 9-57 years). The male to female ratio was 1.9:1. The waiting time was 24.25 +/- 25.2 months. Only 9 recipients had diabetes mellitus. The graft survival rate of the cadaveric group was slightly higher than the living related group: 90.65% vs 87.48%, 88.97% vs 85.05%, 83.04% vs 79.72%, and 76.65% vs 67.78% at 1, 2, 3, and 4 years, respectively (P = .94). Age, sex, waiting time, modality of dialysis, diabetes mellitus, ischemia time, HLA-mismatch, 2 DR-mismatch, delayed graft function (DGF), and body mass index (BMI) had no influence on graft survival. Acute rejection had a negative influence on graft survival in both the LRKT group (P = .09) and the CDKT group (P = .015). Patients who received cyclosporine (CSA), prednisone (Pred), and mycophenolate mofetil (MMF) showed better graft survival than ones on CSA, Pred, and azathioprine (Aza) (P = .18).

There was no significant difference in graft survival between the LRKT and CDKT groups. In this study, only acute rejection was demonstrated to have negative influence on survival rates in CDKT. The timing of transplantation may play a major confounding factor on the results.