Risk Factors Influencing Long-Term Kidney Graft Survival: 13 – Year Expierence Of Kindey Transplantation At The Hospital Of Lithuanian University Of Health Sciences

Background. The number of kidney transplantations is growing rapidly. The attention in the transplantation area is now focused to improve outcomes of kidney transplantation and to find factors determinating long-term graft survival. The aim of this retrospective study was to rewiev a single’s centre expierence and to identify recipient and donor factors influencing the long-term graft survival. Methods. We analysed data of 277 cadaveric renal transplant patients transplanted in renal transplantation center of the Hospital of Lithuanian University of Health Sciences and compared it with previous 10 years analysis of kidney transplantation results in our hospital. Recipient and donor factors which may interact long-term graft survival were compared between ≥5 years (n=100) and <5 years graft survival (n=25) groups. A regression analysis for recipient and donor variables was used to estimate the risk of long-term kidney survival. Results. Overall graft survival was 86.6 %, 79.5 %, 72.4 %, 66.1 % and 58.3 % at 1, 3, 5, 7 and 10 years, respectively. Death-sensored graft survival was 89,6 %, 85,6 %, 80,4 %, 78,7 % and 76,0 % at 1, 3, 5, 7 and 10 years, respectively. On univariate analysis, donor age, history of hypertension of recipient, HLA mismatches and delayed graft function showed significant differences. To determine independent predictive variables for long-term graft survival a multivariate logistic regression was performed. Significant predictors for worse long-term graft survival were older than 40 years donors (OR=3.387, p=0.021), delayed graft function (OR=3.426, p=0.015) and more than 3 HLA mismatches (OR=2.919, p=0.036). Conclusions. Our results show that an younger donor age, excellent early graft function and better immunological compatibility are of particularly importance for long-term graft survival. This leads to conclusion that carefull donor selection, postoperative care and individualization of immunosuppresive protocols are still very important in current transplantation era.