Renal Transplantation in Romania: Where Do We Stand?

Area of Science:

• Nephrology
• Transplantation Medicine
• Public Health

Background:

• Limited data exists on kidney transplant (KTx) outcomes in Romania, with only 8% of renal replacement therapy (RRT) patients receiving KTx in 2012.
• This study addresses the knowledge gap by evaluating KTx patient outcomes in a major Romanian transplant center.
• Comparison is made against hemodialysis (HD) and peritoneal dialysis (PD) patient data from the Romanian Renal Registry (RRR).

Purpose of the Study:

• To assess and compare patient survival rates after kidney transplantation versus long-term dialysis in Romania.
• To identify factors influencing survival in RRT patients within the Romanian healthcare system.
• To advocate for improvements in the national kidney transplantation program.

Main Methods:

• An intention-to-treat analysis was conducted 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.
• Patients were stratified by RRT modality at day 90 of therapy.

Main Results:

• KTx recipients were younger, predominantly male, and more frequently had glomerulonephritis as their primary renal disease (PRD).
• Mean survival time was significantly higher for KTx patients (57.68 months) compared to HD (45.55 months) and PD (46.33 months).
• Multivariate analysis identified older age at RRT initiation, HD/PD as RRT modality, and diabetic nephropathy as PRD as predictors of poorer survival.

Conclusions:

• This study provides the first representative data on KTx patient outcomes in Romania, demonstrating markedly better survival post-transplant compared to HD or PD.
• The findings underscore the critical need for establishing a national KTx registry.
• Implementing a registry is essential for improving Romania's national kidney transplantation program and patient care.