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The sensitized patient. A single center study.

C J Cardella1, J Rochon, A Shoker

  • 1Toronto Western Hospital, Ontario.

Clinical Transplants
|January 1, 1988
PubMed
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Renal transplant outcomes show patient survival at 62% and graft survival at 35% over 10 years. Key factors influencing survival include recipient age, donor source, and time period, with complex interactions involving patient sensitization.

Area of Science:

  • Nephrology
  • Transplant Surgery
  • Immunology

Background:

  • Over a 20-year period (1966-1986), 650 renal transplants were performed at Toronto Western Hospital.
  • The study aimed to analyze factors affecting patient and graft survival in renal transplantation.

Purpose of the Study:

  • To identify independent predictors of patient and graft survival following renal transplantation.
  • To investigate the impact of patient sensitization, in isolation and in conjunction with other factors like age and gender, on renal transplant outcomes.

Main Methods:

  • Multivariant analysis using the Cox proportional hazard model was employed.
  • Predictive models were constructed based on survivorship analysis (Kalbfleisch and Prentice).

Main Results:

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  • Ten-year actuarial patient survival was 62%, and graft survival was 35%.
  • Recipient age, donor source, graft number, and time period independently influenced patient survival.
  • Age and time period independently affected graft outcome.
  • While sensitization alone did not significantly impact graft survival, its interaction with gender and age did. Female patients with high current PRA had significantly lower graft survival.
  • The effect of sensitization on graft survival varied with age: highly sensitized older patients fared better than highly sensitized younger patients, but less sensitized younger patients had better survival than older patients.

Conclusions:

  • Recipient demographics, donor characteristics, and temporal factors are critical determinants of renal transplant success.
  • Patient sensitization presents a complex risk factor, with its impact on graft survival significantly modified by patient age and gender.
  • Predictive models can elucidate the interplay of these variables, aiding in the management and prognostication of renal transplant recipients.