[RISK FACTORS FOR EARLY GRAFT LOSS AFTER KIDNEY TRANSPLANTATION - BEILINSON TRANSPLANT CENTER EXPERIENCE]

Kidney graft failure within the first year after kidney transplantation is a devastating event for the patients and for the transplantation teams. Better understanding of the risk factors for this event may help us to reduce its incidence.

We evaluated the incidence of kidney graft failure (the combined endpoint of patient and graft survival) in the first year after transplantation. Risk factors for this event were calculated using Chi square test for categorical variables and Anova for continuous variables. Logistic regression analysis was used for multivariate analysis.

Between 2002 and 2017, 1735 kidney transplantations were performed in our center in adult patients; 113 (6.5%) of the patients had graft loss during the first year. Of those 45 patients: (2.5%) died with a functioning graft and 68 (3.9%) returned to dialysis, 35 (3.3%) of transplantations with graft loss were from living donors and 78 (11.3%) were from deceased donors (p<0.001).Variables that were found to be associated with graft failure were: recipient age >50 (8.4%vs.4.6%,p=0.01), pre-transplant diabetes (10.1% Vs.5.2%,p<0.001), pre-transplant Ischemic Heart Disease (13.5% Vs.4.8%,p<0.001), >2nd transplant (9.7% Vs. 5.9 %,p<0.021), marginal donor (11.7% Vs. 5.0 %,p<0.01), Delayed Graft Function (19.2% Vs. 4.3 %,p<0.001), and acute rejection (15.4 Vs. 5.5 %,p<0.001). ATG Vs. no or other induction (p=0.04). In multivariate analyses pre-ransplant Diabetes , pre-transplant Ischemic Heart Disease, deceased donor and >2nd transplant were significantly associated with graft loss in the first year after transplantation. In multivariate analysis pre-transplant Diabetes and Ischemic Heart Disease, deceased donor and >2nd transplant were significantly associated with graft loss in the first year after transplantation.

Better selection of transplantation candidates and better selection and preservation of kidneys from deceased donors may reduce graft loss during the first year after kidney transplantation.