Renal Transplantation in Romania: Where Do We Stand?

According to the Romanian Renal Registry (RRR), only 8% of patients on renal replacement therapy (RRT) in 2012 received a kidney transplant (KTx). As not all transplant centers report to RRR, the outcome of transplanted patients in Romania is not known. Therefore, we aimed to evaluate the outcome in patients grafted in one of the largest transplant center in the country as compared to hemodialysis (HD) and peritoneal dialysis (PD) patients recorded by the RRR.

In an intention-to-treat analysis using Kaplan-Meier and Cox proportional hazard (CPH) models, survival was compared between 8050 incident HD, 1000 PD and 490 KTx patients treated between 2008 and 2011. The patients were stratified by modality at day 90 of therapy.

As compared to HD and PD patients, the KTx recipients were younger, more often of male gender, and had glomerulonephritis as primary renal disease (PRD) more frequently. KTx patients had a higher mean survival time (57.68 [56.95-58.42] months) than HD (45.55 [45.04- 46.06] months) or PD patients (46.33 [45.01-47.65] months). In the multivariate CPH model, higher age (OR=1.03 (1.02-1.03), p<0.01) at RRT initiation, HD (OR=5.60 (3.16-9.94), p<0.01) and PD (OR=5.62 (3.14-10.08), p<0.01) as RRT and diabetic nephropathy (p<0.01) as PRD were associated with a poorer survival.

The present study is the first to provide representative information about the outcome of the KTx patients in Romania. We found that patient survival after KTx is markedly better than either HD or PD. Urgent implementation of a KTx registry is needed in order to improve the national transplantation program.